Hemosuccus pancreaticus, also known as pseudohematobilia or Wirsungorrhage is a rare cause of hemorrhage in the gastrointestinal tract. It is caused by a. Methods: We reviewed our experience with management of 17 patients admitted to surgery or gastroenterology units for hemosuccus pancreaticus between. Hemosuccus pancreaticus (HP) is a rare and potentially life threatening clinical entity and is described as bleeding from the ampulla of Vater.

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It can be an important diagnostic and therapeutic tool.

The diagnosis was established in one other patient undergoing exploration for iron-deficiency anemia. Endoscopic ultrasound showed chronic pancreatitis with a heterogeneous inflammatory lesion in the body of the pancreas Fig. The owners of this website hereby guarantee to respect the legal confidentiality conditions, applicable in France, and not to disclose this data to third parties. Visceral angiography is pancreatiicus most sensitive diagnostic technique for a visceral artery aneurysm or pseudoaneurysm.

Contrast-enhanced CT scan of the abdomen reveals dilated pancreatic duct possibly filled with blood.

Hemosuccus Pancreaticus: Year Experience from a Tertiary Care GI Bleed Centre

The source of hemorrhage is usually not determined by standard endoscopic techniques, and the symptoms of the condition are usually pancteaticus as a cause of obscure overt gastrointestinal hemorrhage.

An esophagogastroduodenal barium study was performed in one patient and only demonstrated a widened duodenum. Upper digestive endoscopy and selective digestive angiography during active bleeding can provide panceaticus diagnosis.

Angioembolization failed due to technical reasons partial embolization due to a rich collateral supply and the patient had to undergo emergency surgery.


The haemorrhage hemisuccus usually intermittent, repetitive and, most often, not severe enough to cause haemodynamic instability despite the usual arterial origin of bleeding [ 78 ].

As the CECT showed a pseudoaneurysm of the splenic artery, a ruptured pseudoaneurysm was bemosuccus as the source of the bleeding. Further evaluation with abdominal CT scan, CT angiogram and conventional angiogram revealed no source of blood loss.

CT scan may show simultaneous opacification of an aneurysmal artery and pseudocyst or persistence of a contrast within a pseudocyst after the arterial phase [ 36 ]. Arterial embolization for bleeding pseudocysts complicating chronic pancreatitis.

Hemosuccus pancreaticus: A mini-review

The diagnosis of HP remains challenging. Elastases are observed, in particular. Endovascular treatment by embolization is effective in most patients but there is no consensus concerning the need for associating surgery to achieve complete cure. This potentially life-threatening complication of pancreatitis may pose a significant diagnostic and therapeutic uemosuccus, especially in patients who do not exhibit symptoms such as abdominal pain, jaundice, or GI bleeding.

Other clinical signs are more exceptional and include jaundice, vomiting, weight loss, pancreatcius a palpable pulsating mass with a systolic thrill in the event of aneurysm [ 17 — 9 ]. HP is a rare and potential life-threatening cause of gastrointestinal bleeding.

Hemosuccus pancreaticus: a rare cause of gastrointestinal bleeding

Angiography identified a pseudoaneurysm of the gastroduodenal artery. There is a low risk 0. Balloon tamponade and stent placement can be used as a bridge to elective surgery.

Two patients developed infectious complications: There are two potential approaches: However it also occludes the artery and ischemia can develop in the tissue supplied by the artery pancrdaticus the collateral supply is poor.

The objective of our study is to highlight the challenges in the diagnosis and management of HP and to formulate a protocol to effectively and safely manage this condition. Patients with hemosuccus may develop symptoms of gastrointestinal hemorrhage, such as blood in the stools, maroon stools, or melenawhich is a dark, tarry stool caused by digestion of red blood cells.


Angiography identifies the causative artery and allows for delineation of the arterial anatomy and therapeutic intervention. Approximately cases have been reported in the literature since it was first reported by Lower and Farrell in [ 3 ].

This compares favorably with the mortality rate of our series 7. It is difficult to diagnose HP because the hemozuccus is usually intermittent. CECT abdomen showing a large pseudoaneurysm of the splenic artery black arrow Case 1.

The patient was having intermittent epigastric abdominal pain for about 3 weeks which waxed and waned without intervention.

Six patients were managed conservatively. Both cases were successfully managed by surgery. Angiography usually not performed as most patients are critically ill when considered for angiography. A year-old male with a history of chronic alcoholism having a 3-week history of alcohol-related severe acute pancreatitis was referred to our institution for a necrosectomy. Diseases of the pancreas include acute and chronic pancreatitis[6] pancreatic cancer[2] pancreatic duct stones, [7] ruptured aneurysms of the splenic artery, [4] and pseudoaneurysms of the splenic artery [8] and hepatic artery.

On precontrast CT, the characteristic finding of clotted blood in the pancreatic duct, known as the pancreatcius clot, is seldom seen.