Hemosuccus pancreaticus treated with gastroduodenopancreatectomy: a case report and review of literature

Abstract

Introduction: Hemosuccus pancreaticus is a rare cause of upper gastrointestinal bleeding and usually occurs as a complication of chronic or acute pancreatitis. Its recognition requires a high clinical suspicious, and sometimes the complementary exams are only suggestive but not definitive for diagnosis. The treatment strategy depends on the cause of the hemosuccus pancreaticus. Case Report: We report a patient with chronic pancreatitis that presented acute abdominal pain and acute upper gastrointestinal bleeding. An upper digestive endoscopy showed an active bleeding from the major duodenal papillae, leading the diagnosing of hemosuccus pancreaticus. An abdominal Angio-CT scan identified a gastroduodenal artery aneurism, followed with embolization of this aneurism. Due to recurrence of bleeding, the patient was submitted to a gastroduodenopancreatectomy, as a rescue measure after embolization failure. Conclusion: The diagnosis for hemosuccus pancreaticus requires a high clinical suspicious, once the visualization of an active bleeding during an upper digestive endoscopy occurs in the minority of cases. Angioembolization is the initial therapy in many cases, but sometimes surgical procedures are mandatory for a definitive treatment.