Hemosuccus Pancreaticus in Gastrointestinal Hemorrhage

Hemosuccus pancreaticus is a rare but potentially life-threatening cause of upper gastrointestinal bleeding, characterised by intermittent haemorrhage through the ampulla of Vater via the pancreatic duct. It most commonly arises from rupture of a pseudoaneurysm in a peripancreatic artery, particularly the splenic or gastroduodenal artery, often in the setting of acute or chronic pancreatitis. Clinically, patients present with a triad of intermittent abdominal pain, melaena or haematochezia, and elevated pancreatic enzymes. The diagnosis is frequently delayed by the episodic nature of bleeding and the limited sensitivity of conventional endoscopy. Cross-sectional imaging such as contrast-enhanced computed tomography and magnetic resonance imaging can identify pseudoaneurysms and active extravasation, but selective angiography remains the diagnostic gold standard and offers a therapeutic window. Management has shifted from open surgery towards minimally invasive endovascular interventions, typically coil embolisation, which achieves haemostasis in the majority of cases. In centres with advanced endoscopic capabilities, endoscopic ultrasound and retrograde cholangiopancreatography play an emerging role in localisation and guidance of targeted therapies. Successful outcomes depend on rapid recognition, a multidisciplinary team approach, and access to interventional radiology or endoscopy facilities.

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Hemosuccus Pancreaticus in Gastrointestinal Hemorrhage publication trend

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Technical terms

Pseudoaneurysm: A contained rupture of an arterial wall forming a blood-filled sac communicating with the parent vessel.

Coil embolisation: Endovascular placement of metal coils into a bleeding vessel or pseudoaneurysm to induce thrombosis and achieve haemostasis.

Endoscopic retrograde cholangiopancreatography (ERCP): An endoscopic technique combining fluoroscopy and endoscopy to visualise and intervene in the biliary and pancreatic ducts.

Endoscopic ultrasound (EUS): An imaging modality that uses high-frequency ultrasound via an endoscope to visualise structures adjacent to the gastrointestinal tract and guide therapeutic interventions.

References

1. Hemosuccus Pancreaticus: A Comprehensive Review of Presentation Patterns, Diagnostic Approaches, Therapeutic Strategies, and Clinical Outcomes. Journal of Investigative Medicine High Impact Case Reports (2022).
2. A case report on the role of endoscopic retrograde cholangiopancreatography in the diagnosis of hemosuccus pancreaticus. Medicine (2022).
3. Endoscopic Ultrasound-Guided Glue Embolization for Left Gastric Artery Pseudoaneurysm Presenting as Hemosuccus Pancreaticus After Failed Radiological Intervention. ACG Case Reports Journal (2024).