Hemosuccus Pancreaticus

Abstract

A 24-year-old woman with systemic lupus erythematosus presented to the hospital with acute pancreatitis and melena. Upper endoscopy revealed active hemorrhage via the ampulla of Vater. Visceral arteriography was initially unremarkable. Subsequent provocative arteriography (Fig 1, early and late phases were combined) with visceral injection of 2 mg tissue plasminogen activator, 3,000 U heparin, and 100 µg nitroglycerin revealed extravasation from the pancreatica magna artery (short arrow, Fig 1) into the pancreatic duct (long arrow, Fig 1) and duodenum (arrowheads, Fig 1). A 2 × 3-mm platinum coil was embolized into this branch; completion arteriogram (Fig 2, arrow points to coil) demonstrated hemostasis. Her abdominal pain and hemorrhage resolved, but recurrent melena 1 week later necessitated another arteriogram (not shown); minimal pancreatic duct opacification from a bleeding caudal pancreatic arterial branch was identified and embolized. Four months later, there had been no recurrent bleeding and the patient was gaining strength. Figure 2 View Large Image Figure Viewer Download Hi-res image