Diagnosis and treatment of hemosuccus pancreaticus during a nonbleeding episode: A case report of a patient with obscure intermittent gastrointestinal bleeding and silent chronic pancreatitis.
BACKGROUND
Hemorrhage from the pancreatic duct, i.e. hemosuccus pancreaticus (HP), is a rare cause of gastrointestinal bleeding. This potentially life-threatening complication of chronic pancreatitis may pose a significant diagnostic and therapeutic dilemma, especially in patients with silent forms of the disease.


METHODS
We report a case of a 64-year-old man with no history or symptoms but positive findings of chronic calcifying pancreatitis at computed tomography (CT) scan.


RESULTS
The patient presented with repeated episodes of gastrointestinal bleeding requiring transfusion and did not, until later in the disease, develop hyperamylasemia and epigastric pain. Repeated endoscopies could not reveal the source of bleeding. The radiological diagnosis and successful transcatheter embolization of a small splenic pseudoaneurysm were performed during an interval when the patient was asymptomatic and showed no signs of bleeding.


CONCLUSIONS
We suggest that when HP is suspected, a contrast-enhanced CT angiography with reconstruction of the arteries should be performed regardless of whether the patient shows signs of active bleeding or not.
Strömmer
Lisa
L
Department of Surgery, Center for Surgical Sciences at Karolinska Institutet at Huddinge University Hospital, Stockholm, Sweden. Lisa.Strommer@cfss.ki.se
Albiin
Nils
N
Calissendorff
Bertil
B
Granlund
Håkan
H
Permert
Johan
J
D000681:Amylases / Q000097:blood; D001803:Blood Transfusion; D002908:Chronic Disease; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D006470:Hemorrhage / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain; D010182:Pancreatic Diseases / Q000175:diagnosis* / Q000628:therapy; D010183:Pancreatic Ducts; D010195:Pancreatitis / Q000150:complications* / Q000175:diagnosis; D014057:Tomography, X-Ray Computed
D000681:Amylases