How to diagnose and treat hemosuccus pancreaticus?

Hemorrhage from the papilla of Vater via the pancreatic duct, known as hemosuccus pancreaticus, is a rare cause of intermittent upper gastrointestinal bleeding. Until now, reports on hemosuccus pancreaticus are quite limited. Difficulty of determining the location of bleeding sometimes causes delay of treatment and critical condition of patients. The causes of hemorrhage were rupture of pseudoaneurysm of the splenic artery and bleeding from the wall of pancreatic pseudocyst. Interventional radiology is the first modality for early diagnosis and possible treatment of hemosuccus pancreaticus. When angiography shows no abnormal findings or interventional radiological therapy can not be successful, surgery should be considered without delay.

This study, performed by a team lead by Dr. Toyoki, is described in a research article to be published in the May 7 issue of the World Journal of Gastroenterology.

In view of the authors, patients herein underwent surgery without recurrence or sequilae. Intraoperative ultrasonography and pancreatoscopy were helpful modality for confirming the source of hemorrhage and determining the cutting line of the pancreas. When they encounter intermittent upper gastrointestinal bleeding with an obscure source, hemosuccus pancreaticus should be included in differential diagnoses especially in patients with chronic pancreatitis, which would lead a prompt and proper treatment.

It is necessary that repeated examinations and careful observations are performed for diagnosis of obscure source of repeated upper gastrointestinal bleeding and hemosuccus pancreaticus should be included in differential diagnosis. The treatment for hemosuccus pancreaticus should be tried to perform interventional radiological therapy at first. And then, surgical treatment is necessary when angiography show no abnormal findings and interventional radiological therapy can not be successful. At surgery, intraoperative ultrasonography and pancreatoscopy should be performed because of confirming the origin of hemorrhage.