title: Hemosuccus pancreaticus from a splenic artery pseudoaneurysm: an unusual cause of upper gastrointestinal bleeding.
abstract: Hemorrhage through the pancreatic duct into the duodenum, so called "hemosuccus pancreaticus", is a rare cause of gastrointestinal bleeding with diagnostic difficulties. We report a 60-year-old man with recurrent upper gastrointestinal bleeding due to rupture of a splenic artery pseudoaneurysm into the pancreatic duct. Initial upper gastrointestinal endoscopy failed to identify the site of the hemorrhage. Abdominal computed tomography disclosed a cystic mass containing a well-enhanced spherical area at the pancreatic tail. Arterial blood flow was demonstrated in the lesion by Doppler ultrasound. Celiac angiography demonstrated a saccular pseudoaneurysm arising from the splenic artery. Bleeding from the ampulla of Vater located in a big duodenal diverticulum was found on repeat endoscopy. Surgical resection of the pseudoaneurysm with distal pancreatectomy and splenectomy was successfully performed. The patient remained symptom-free 5 months after the operation. Hemosuccus pancreaticus, although rare, remains important in the differential diagnosis of upper gastrointestinal bleeding of obscure origin.
authors.affiliation: Departments of Internal Medicine, National Taiwan University Hospital, Taipei.
authors.forename: Y T
authors.initials: YT
authors.lastname: Hwang
authors.forename: C H
authors.initials: CH
authors.lastname: Chen
authors.forename: H P
authors.initials: HP
authors.lastname: Wang
authors.forename: P M
authors.initials: PM
authors.lastname: Yang
authors.forename: S C
authors.initials: SC
authors.lastname: Yu
authors.forename: C T
authors.initials: CT
authors.lastname: Wu
authors.forename: T H
authors.initials: TH
authors.lastname: Wang
authors.forename: J T
authors.initials: JT
authors.lastname: Lin
mesh_terms: D017541:Aneurysm, False / Q000150:complications* / Q000601:surgery; D003937:Diagnosis, Differential; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts; D010185:Pancreatic Fistula / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D013157:Splenic Artery; D013624:Taiwan