title: Haemosuccus pancreaticus: diagnostic and therapeutic challenges.
abstract: BACKGROUND
  Haemosuccus pancreaticus (HP) is a rare cause of upper gastrointestinal bleeding. The objective of our study was to highlight the challenges in the diagnosis and management of HP.
  
  
  METHODS
  The records of 31 patients with HP diagnosed between January 1997 and June 2008 were reviewed retrospectively.
  
  
  RESULTS
  Mean patient age was 34 years (11-55 years). Twelve patients had chronic alcoholic pancreatitis, 16 had tropical pancreatitis, two had acute pancreatitis and one had idiopathic pancreatitis. Selective arterial embolization was attempted in 22 of 26 (84%) patients and was successful in 11 of the 22 (50%). Twenty of 31 (64%) patients required surgery to control bleeding after the failure of arterial embolization in 11 and in an emergent setting in nine patients. Procedures included distal pancreatectomy and splenectomy, central pancreatectomy, intracystic ligation of the blood vessel, and aneurysmal ligation and bypass graft in 11, two, six and one patients, respectively. There were no deaths. Length of follow-up ranged from 6 months to 10 years.
  
  
  CONCLUSIONS
  Upper gastrointestinal bleeding in a patient with a history of chronic pancreatitis could be caused by HP. Diagnosis is based on investigations that should be performed in all patients, preferably during a period of active bleeding. These include upper digestive endoscopy, contrast-enhanced computed tomography (CECT) and selective arteriography of the coeliac trunk and superior mesenteric artery. Contrast-enhanced CT had a high positive yield comparable with that of selective angiography in our series. Therapeutic options consist of selective embolization and surgery. Endovascular treatment can control unstable haemodynamics and can be sufficient in some cases. However, in patients with persistent unstable haemodynamics, recurrent bleeding or failed embolization, surgery is required.
authors.affiliation: Department of Surgical Gastroenterology, Centre for Gastrointestinal Bleed, Division for Hepato Biliary Pancreatic Diseases and liver transplantation, Government Stanley Medical College Hospital, Chennai, Tamilnadu, India.
authors.forename: Velayutham
authors.initials: V
authors.lastname: Vimalraj
authors.forename: Devy Gounder
authors.initials: DG
authors.lastname: Kannan
authors.forename: Ramaswami
authors.initials: R
authors.lastname: Sukumar
authors.forename: Shanmugasundaram
authors.initials: S
authors.lastname: Rajendran
authors.forename: Satyanesan
authors.initials: S
authors.lastname: Jeswanth
authors.forename: Damodaran
authors.initials: D
authors.lastname: Jyotibasu
authors.forename: Palaniappan
authors.initials: P
authors.lastname: Ravichandran
authors.forename: Tirupporur Govindaswamy
authors.initials: TG
authors.lastname: Balachandar
authors.forename: Rajagopal
authors.initials: R
authors.lastname: Surendran