Hemosuccus Pancreaticus - A Rare Cause of Gastrointestinal Bleeding: Diagnosis and Interventional Radiological Therapy

Hemorrhage from the pancreatic duct, i. e. hemosuccus pancreaticus (HP), is a rare cause of gastrointestinal bleeding. Pancreatic hemosuccus is usually due to the rupture of an aneurysm of a visceral artery, most likely the splenic artery, in chronic pancreatitis. Other causes of HP are rare. We present a case of HP in a female patient with no history but with positive findings of chronic calcifying pancreatitis upon ultrasonographic investigation, computed tomography scan, and endoscopic retrograde cholangiopancreatography. With detectable fresh blood in the descending duodenum, angiography of the celiac artery revealed an aneurysm of the splenic artery as the suspected cause of intermittent bleeding from the pancreatic duct. The treatment is traditionally surgical or by interventional radiological means. This is the first case described in the literature in which interventional radiological therapy involved implantation of an uncoated metal Palmaz stent in the splenic artery. In the follow-up of 18 months no relapse of HP was observed.

References

• 1 Börjesson B, Evander A, Ihse I, et al. Gastrointestinal bleeding caused by haemosuccus pancreaticus. A presentation of two cases.  Acta Chir Scand. 1981;  147 299-301
• 2 Yokoyama I, Hashmi A, Srinivas D, et al. Wirsungorrhagia or hemoductal pancreatitis: report of a case and review of the literature.  Am J Gastroenterol. 1984;  79 764-768
• 3 Kahle M, Schober G, Bachfischer K, Walther H. Das komplizierte Lienalis-Aneurysma.  Dtsch Med Wochenschr. 1992;  117 1789-1793
• 4 Risti B, Marincek B, Jost R, et al. Hemosuccus pancreaticus as a source of obscure upper gastrointestinal bleeding: three cases and literature review.  Am J Gastroenterol. 1995;  90 1878-1880
• 5 Allgaier H P, Blum U, Haag K, et al. Haemosuccus pancreaticus - seltene Ursache einer oberen gastrointestinalen Blutung.  Dtsch Med Wochenschr. 1996;  121 1158-1162
• 6 Cahow C E, Gusberg R J, Gottlieb L J. Gastrointestinal hemorrhage from pseudo-aneurysms in pancreatic pseudocysts.  Am J Surg. 1983;  145 534-541
• 7 Rao R C, Kumar A, Berry M. Pseudoaneurysm of anomalous right hepatic artery as a cause for hemosuccus pancreatitis.  Gastrointest Radiol. 1987;  12 313-314
• 8 De Mas R, Kohler B, Ante D, et al. Hämosuccus pancreaticus nach Ruptur eines A. hepatica-Aneurysmas.  Z Gastroenterol. 1989;  27 736-738
• 9 Jakobs R, Riemann J F. Haemosuccus pancreaticus durch ein Druckulcus bei Pankreolithiasis.  Dtsch Med Wochenschr. 1992;  117 1956-1961
• 10 Bretagne J F, Heresbach D, Darnault P, et al. Pseudoaneurysms and bleeding pseudocysts in chronic pancreatitis: radiological findings and contribution to diagnosis in 8 cases.  Gastrointest Radiol. 1990;  15 9-16
• 11 Perez C, Llauger J, Pallardo Y, et al. Radiologic diagnosis of pseudoaneurysms complicating pancreatitis.  Eur J Radiol. 1993;  16 102-106
• 12 Baker K S, Tisnado J, Cho S R, Beachley M C. Splanchnic artery aneurysms and pseudoaneurysms: transcatheter embolization.  Radiology. 1987;  163 (1) 135-139
• 13 Mandel S R, Jaques P F, Sanofsky S, Mauro M A. Nonoperative management of peri-pancreatic arterial aneurysms. A 10-year experience.  Ann Surg. 1987;  205 126-128
• 14 Hashizume M, Ohta M, Ueno K, et al. Laparoscopic ligation of splenic artery aneurysm.  Surgery. 1993;  113 352-354
• 15 Saw E C, Ku W, Ramachandra S. Laparoscopic resection of a splenic artery aneurysm.  J Laparoendosc Surg. 1993;  3 167-171
• 16 McDermott V G, Shlansky-Goldberg R, Cope C. Endovascular management of splenic artery aneurysms and pseudoaneurysms.  Cardiovasc Intervent Radiol. 1994;  17 179-184
• 17 Lower W E, Farell J L. Aneurysma of a splenic artery: report of a case and review of the literature.  Arch Surg. 1931;  23 182-190
• 18 Lambert C J, Williamson J W. Splenic artery aneurysm. A rare cause of upper gastro-intestinal bleeding.  Am Surg. 1990;  56 543-545
• 19 Kuhn R, Janocha F, Lazar A, et al. Rupturiertes Pseudoaneurysma der Arteria lienalis.  Dtsch Med Wochenschr. 1996;  121 1567-1570
• 20 Dinu F, Devière J, von Gossum A, et al. The wirsungorrhagies: causes and management in 14 patients.  Endoscopy. 1998;  30 595-600