Subscribe to RSS
DOI: 10.1055/s-2004-814417
Hemosuccus Pancreaticus Secondary to Intraductal Rupture of a Primary Splenic Artery Aneurysm: Diagnosis by ERCP and Successful Management by Interventional Radiology
Publication History
Submitted 11 December 2002
Accepted after Revision 17 September 2003
Publication Date:
21 April 2004 (online)

This report describes the case of a 65-year-old man with a prolonged history of gastrointestinal bleeding of unknown origin. During a 2-year period, he underwent 28 endoscopic procedures, three angiographies with or without heparin provocation, a nuclear scan, and abdominal magnetic resonance imaging, none of which were diagnostic. A blind ileocecal resection was also carried out. A diagnosis of hemosuccus pancreaticus secondary to a ruptured primary splenic artery aneurysm was obtained by endoscopic retrograde cholangiopancreatography, and successful interventional radiographic embolization of the splenic artery aneurysm was conducted. During a 17-month follow-up period, no relapse of gastrointestinal bleeding was observed.
References
- 1 Sandbloom P. Gastrointestinal hemorrhage through the pancreatic duct. Ann Surg. 1970; 171 61-62
- 2 Wagner W H, Cossman D V, Treiman R L. et al . Hemosuccus pancreaticus from intraductal rupture of a primary splenic artery aneurysm. J Vasc Surg. 1994; 19 158-164
- 3 Lower W E, Farrell J I. Aneurysm of the splenic artery: report of a case and review of the literature. Arch Surg. 1932; 23 182-190
- 4 Suter M. Haemorrhage into the pancreatic duct (hemosuccus pancreaticus): recognition and management. Eur Surg. 1995; 161 887-892
- 5 Starling J R, Crummy A B. Hemosuccus pancreaticus secondary to ruptured splenic artery aneurysm. Dig Dis Sci. 1979; 24 726-729
- 6 Morse J M, Reddy K R, Thomas E. Hemosuccus pancreaticus: a cause for obscure gastrointestinal bleeding - diagnosis by endoscopy and successful management by total parenteral nutrition. Am J Gastroenterol. 1983; 78 572-574
- 7 Jakobs R, Riemann J F. Hemosuccus pancreaticus due to a pressure ulcer in pancreatolithiasis [in German]. Dtsch Med Wochenschr. 1992; 117 1956-1961
- 8 Longmire W P , Rose A S . Hemoductal pancreatitis. Surg Gynecol Obstet. 1973; 136 246-250
- 9 Stanley J C, Wakefield T W, Graham L M. et al . Clinical importance and management of splanchnic artery aneurysms. J Vasc Surg. 1986; 3 836-840
- 10 Cahow C E, Gusberg R J, Gottlieb L J. Gastrointestinal hemorrhage from pseudoaneurysms in pancreatic pseudocysts. Am J Surg. 1983; 145 534-541
- 11 Jones E L, Finney G G Jr. Splenic artery aneurysms: a reappraisal. Arch Surg. 97 1968; 740-747
- 12 Clay R P, Farnell M B, Lancaster J R. et al . Hemosuccus pancreaticus: an unusual cause of upper gastrointestinal bleeding. Ann Surg. 1985; 202 75-79
- 13 Koizumi J, Inoue S, Yonekawa H, Kunieda T. Hemosuccus pancreaticus: diagnosis with CT and MRI and treatment with transcatheter embolization. Abdom Imag. 2002; 27 77-81
- 14 Kim S S, Roberts R R, Nagy K K. et al . Hemosuccus pancreaticus after penetrating trauma to the abdomen. J Trauma. 2000; 49 948-950
- 15 Akpinar H, Dicle O, Ellidokuz E. et al . Hemosuccus pancreaticus treated by transvascular selective arterial embolization. Endoscopy. 1999; 31 213-214
- 16 Sukerkar A N, Dulay C C, Anaudappa E, Asokan S. Mycotic aneurysm of the hepatic artery: case diagnosed with radionuclide imaging and ultrasound. Radiology. 1977; 124 444
- 17 Benz C A, Jakob P, Jakobs R, Riemann J F. Hemosuccus pancreaticus: a rare cause of gastrointestinal bleeding: diagnosis and interventional radiological therapy. Endoscopy. 2000; 32 428-431
G. Costamagna, M. D.
Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, ”A. Gemelli” University Hospital
Largo A. Gemelli 8 · 00168 Rome · Italy
Fax: +39-06-3015 6581
Email: gcostamagna@rm.unicatt.it