Korean J Gastrointest Endosc.  2004 May;28(5):267-272.

A Case of Hemosuccus Pancreaticus Showing Active Bleeding from the Ampulla of Vater

• Son HB
• Moon YS
• Yang JH
• Ham CR
• Lee SH
• Ryu U
• Roh JW
• Lee SE
• Kim KA
• Han YH

Abstract

Hemorrhage through the pancreatic duct into the duodenum, so called 'hemosuccus pancreaticus', is a rare cause of gastrointestinal bleeding with diagnostic difficulties. We report a 44-year-old man with recurrent upper gastrointestinal bleeding due to rupture of pseudoaneurysm into the pancreatic duct. Initial upper gastrointestinal endoscopy failed to identity the site of the hemorrhage. Active bleeding from the ampulla of Vater in duodenum was found on repeat endoscopy. Abdominal computed tomography disclosed pseudoaneurysm arising from the splenic artery caused by chronic pancreatitis. Splenic angiogram showed large psudoaneurysmal sac with wide neck, arising from distal splenic artery. Angiographic embolization was successful in controlling the arterial hemorrhage. The patient remained symptom-free 5 months after the embolization. Hemosuccus pancreaticus, although rare, remains important in the differential diagnosis of upper gastrointestinal bleeding of obscure orgin.

Keyword

Hemosuccus pancreaticus; Rupture of pseudoaneurysm; Chronic pancreatitis

MeSH Terms

Adult
Ampulla of Vater*
Aneurysm, False
Diagnosis, Differential
Duodenum
Endoscopy
Endoscopy, Gastrointestinal
Hemorrhage*
Humans
Neck
Pancreatic Ducts
Pancreatitis, Chronic
Rupture
Splenic Artery