Hemosuccus pancreaticus: A rare complication in patients with chronic pancreatitis

Background: Hemosuccus pancreaticus is pancreatic hemorrhage which passes via the pancreatic duct into the duodenum through the ampulla of Vater. It is a rare condition usually occurring in patients with a history of chronic pancreatitis and a pseudocyst. Exudation of pancreatic proteolytic enzymes leads to the gradual autodigestion of nearby vessel walls, resulting in the formation of a pseudoaneurysm. The pseudoaneurysm eventually ruptures into the pancreatic duct, directly or within a pseudocyst. Methods: We report the case of a 45-year-old alcoholic male presenting with melena and complaints of intermittent epigastric pain. Upper endoscopy showed active bleeding from the ampulla of Vater. Chronic calcific pancreatitis and a pseudoaneurysm within a pancreatic pseudocyst were seen on computed tomography (CT) scan. These findings raised our concern for the diagnosis of hemosuccus pancreaticus and appropriate studies were performed. Results: An angiogram was performed and showed a large bilobed pseudoaneurysm which filled from the gastroduodenal artery and from the inferior pancreaticoduodenal artery off the superior mesenteric artery. Extensive embolization was performed with subsequent resolution of contrast opacification of the pseudoaneurysm. The patient had no further episodes of gastrointestinal bleeding and was discharged from the hospital in stable condition.