title: Endovascular management of hemosuccus pancreaticus, a rare case report of gastrointestinal bleeding.
abstract: BACKGROUND
  Hemorrhage from the pancreatic duct, or hemosuccus pancreaticus (HP), is an unusual cause of intermittent gastrointestinal bleeding. HP is most often diagnosed in patients with chronic pancreatitis, and is usually due to the rupture of an aneurysm in the splenic artery. The traditional treatment for HP is surgery, although most cases can be managed by angioembolization.
  
  
  METHODS
  We present a case of HP in a patient with no history or evidence of chronic pancreatitis. Repeated endoscopy revealed fresh bleeding from the papilla of Vater. Angiography revealed an aneurysm of the splenic artery, which was the suspected cause of the intermittent bleeding from the pancreatic duct. Angiography demonstrated extravasation of contrast from the aneurysm. A peripheral Jostent stent-graft was hand-mounted on an angioplasty balloon and then inserted into the aneurysm. Arteriography revealed successful occlusion of the aneurysm with the stent-graft. No recurrent gastrointestinal bleeding was observed during the five years follow-up periods.
  
  
  CONCLUSIONS
  HP should be included in the differential diagnosis of intermittent gastrointestinal bleeding in patients with histories of chronic alcoholism, even when they do not have a history of chronic pancreatitis. We recommend an interventional procedure with a metal stent for the initial treatment of HP.
authors.affiliation: Department of Internal Medicine, Chung-Ang University College of Medicine, 224-1 Heuk Seok-Dong, Dongjak-Ku, Seoul, 156-755, Republic of Korea.
authors.forename: Hye Ryoung
authors.initials: HR
authors.lastname: Sul
authors.affiliation: Department of Internal Medicine, Chung-Ang University College of Medicine, 224-1 Heuk Seok-Dong, Dongjak-Ku, Seoul, 156-755, Republic of Korea. lhwdoc@hanmail.net.
authors.forename: Hyun Woong
authors.initials: HW
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Chung-Ang University College of Medicine, 224-1 Heuk Seok-Dong, Dongjak-Ku, Seoul, 156-755, Republic of Korea.
authors.forename: Jeong Wook
authors.initials: JW
authors.lastname: Kim
authors.affiliation: Department of Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
authors.forename: Sung Jae
authors.initials: SJ
authors.lastname: Cha
authors.affiliation: Department of Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
authors.forename: Yoo Shin
authors.initials: YS
authors.lastname: Choi
authors.affiliation: Department of Radiology, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
authors.forename: Gi Hyeon
authors.initials: GH
authors.lastname: Kim
authors.affiliation: Department of Radiology, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
authors.forename: Byung Kook
authors.initials: BK
authors.lastname: Kwak
mesh_terms: D014670:Ampulla of Vater / Q000098:blood supply*; D017542:Aneurysm, Ruptured / Q000150:complications / Q000628:therapy*; D000800:Angioplasty, Balloon / Q000379:methods*; D003937:Diagnosis, Differential; D016099:Endoscopy, Gastrointestinal; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000150:complications / Q000628:therapy*; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging; D011859:Radiography; D013157:Splenic Artery / Q000000981:diagnostic imaging; D015607:Stents