Diagnosis and treatment of hemosuccus pancreaticus: development of endovascular management.
OBJECTIVE
The purpose of this study was to analyze the diagnostic and therapeutic features of hemosuccus pancreaticus.


METHODS
We reviewed our experience with management of 17 patients admitted to surgery or gastroenterology units for hemosuccus pancreaticus between 1981 and 2005. We studied symptoms, contribution of established morphological examinations (upper digestive endoscopy, computed tomography, and selective digestive angiography), and treatment.


RESULTS
Fifteen men and two women with a mean age of 57 years presented hemosuccus pancreaticus. All the men had a history of chronic alcoholic pancreatitis. Thirteen patients (76.5%) presented overt digestive bleeding (5 melena, 2 hematochezia, 2 melena with hematochezia, and 4 hematemesis). The inaugural sign was anemia in 2 patients and epigastric pain another 2 patient. An upper digestive endoscopy was performed in 15 patients and visualized hemosuccus pancreaticus directly in 9 patients. Arteriography was performed in 16 patients (94.1%) and made the diagnosis in 14 (87.5%). Surgery was performed in 9 patients, after embolization in 2 patients. Embolization was performed in 9 patients and effective in 7 patients. Therapeutic abstention proved successful in 1 patient. There were no death and no recurrent bleeding.


CONCLUSIONS
Hemosuccus pancreaticus is a rare cause of digestive bleeding. Upper digestive endoscopy and angiography during active bleeding can provide the diagnosis. Most cases can be managed by angioembolization. However, in patients with recurrent bleeding or failed embolization, emergency surgery is required.
Lermite
Emilie
E
Service de chirurgie viscérale, CHU Angers, Angers, France.
Regenet
Nicolas
N
Tuech
Jean-Jacques
JJ
Pessaux
Patrick
P
Meurette
Guillaume
G
Bridoux
Valérie
V
Aubé
Christophe
C
Arnaud
Jean-Pierre
JP
D000328:Adult; D000368:Aged; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D000792:Angiography; D004621:Embolization, Therapeutic; D016145:Endoscopy, Digestive System; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019512:Pancreatitis, Alcoholic / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed