title: Hemosuccus pancreaticus: a rare cause of gastrointestinal bleeding.
abstract: OBJECTIVE
  The purpose of this study was to analyze the diagnostic and therapeutic features of hemosuccus pancreaticus.
  
  
  METHODS
  We conducted a retrospective study of nine patients (eight men and one woman, mean age 60 yrs) admitted to surgery or gastroenterology units for hemossucus pancreaticus between 1981 and 2003. The following were studied: symptoms, contribution of established morphologic exams (upper digestive endoscopy, computed tomography (CT) and selective digestive angiography) and treatment.
  
  
  RESULTS
  Hemosuccus pancreaticus occurred in chronic alcoholic pancreatitis (N=8) and chronic familial pancreatitis (N=1). Seven patients (77.8%) presented overt digestive bleeding (one melena, two hematochezia, two melena with hematochezia, one hematemesis, one hemorrhagic shock). The inaugural sign was anemia in one patient and epigastric pain in another. An upper digestive endoscopy, performed in eight patients (88.9%), revealed fresh red blood in the first or second duodenum in three and hemossucus pancreaticus in three others. Arteriography was performed in eight patients (88.9%) and CT angiography in one. Surgery was performed in 5 patients (55.6%), after embolization in one. Embolization was effective in 3 patients. Therapeutic abstention proved successful in one patient. There were no deaths.
  
  
  CONCLUSIONS
  Hemosuccus pancreaticus is a rare cause of digestive bleeding. Upper digestive endoscopy and selective digestive angiography during active bleeding can provide the diagnosis. Endovascular treatment can control an unstable hemodynamic situation before elective surgery to prevent recurrence, which can be more severe than the first event.
authors.affiliation: Service de Chirurgie Viscérale, CHU Angers, 4 rue Larrey, 49033 Angers Cedex 01.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Etienne
authors.forename: Patrick
authors.initials: P
authors.lastname: Pessaux
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Tuech
authors.forename: Paul
authors.initials: P
authors.lastname: Lada
authors.forename: Emilie
authors.initials: E
authors.lastname: Lermite
authors.forename: Olivier
authors.initials: O
authors.lastname: Brehant
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Arnaud
mesh_terms: D000783:Aneurysm / Q000175:diagnosis* / Q000601:surgery; D004386:Duodenum; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010182:Pancreatic Diseases / Q000175:diagnosis* / Q000601:surgery; D012189:Retrospective Studies; D013156:Splenectomy; D013157:Splenic Artery / Q000601:surgery