Clinical Journal of Gastroenterology

, Volume 12, Issue 1, pp 88–91 | Cite as

Hemosuccus pancreaticus from superior mesenteric artery pseudoaneurysm within perceived pancreatic mass

  • Michelle Maggie ShnayderEmail author
  • Prasoon Mohan
Case Report


Bleeding from the pancreatic duct is a rare source of gastrointestinal hemorrhage and is referred to as hemosuccus pancreaticus. Often a result of pseudoaneurysm formation from chronic pancreatitis, hemosuccus pancreaticus is a difficult diagnosis due to its peculiar clinical presentation. This is a case of a 51-year-old male with a history of chronic pancreatitis, who initially presented with a pancreatic mass found on CT scan. The mass was found to be inconclusive for malignancy on endoscopic ultrasound-guided fine needle aspiration. The patient subsequently was lost to follow-up and returned with melena and evidence of a superior mesenteric pseudoaneurysm in the previous mass on CT angiography. The pseudoaneurysm was successfully treated with endovascular embolization. Diagnosis of hemosuccus pancreaticus can be challenging due to the intermittent nature of hemorrhage and the variable clinical presentation—which initially appeared as a pancreatic neoplasm in our patient. Repeat imaging and angiography are invaluable for both the diagnosis and treatment of gastrointestinal bleeding from an unknown source in the setting of chronic pancreatitis.


Hemosuccus pancreaticus Superior mesenteric artery Pseudoaneurysm Embolization Chronic pancreatitis 


Compliance with ethical standards

Conflict of interest

Michelle Shnayder, M.D., M.P.H, and Prasoon Mohan, M.D., declare that they have no conflict of interest.

Research involving human and/or animal rights

All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from all patients for being included in the study.


  1. 1.
    Benz C, Jakob P, Jakobs R, et al. Hemosuccus pancreaticus—a rare cause of gastrointestinal bleeding: diagnosis and interventional radiological therapy. Endoscopy. 2000;32:428–31.CrossRefGoogle Scholar
  2. 2.
    Ferreira J, Tavares AB, Costa E, et al. Hemosuccus pancreaticus: a rare complication of chronic pancreatitis. BMJ Case Rep. 2015;bcr2015:209–872.Google Scholar
  3. 3.
    Kapoor S, Rao P, Pal S, et al. Hemosuccus pancreaticus: an uncommon cause of gastrointestinal hemorrhage. A case report. JOP. 2004;5:373–6.Google Scholar
  4. 4.
    Kothari RA, Leelakrishnan V, Krishnan M. Hemosuccus pancreaticus: a rare cause of gastrointestinal bleeding. Ann Gastroenterol. 2013;26:175.Google Scholar
  5. 5.
    Maddah G, Abdollahi A, Golmohammadzadeh H, et al. Hemosuccus pancreaticus as a rare cause of gastrointestinal bleeding: a report of two cases. Acta Med Iran. 2015;53:320–3.Google Scholar
  6. 6.
    Risti B, Marincek B, Jost R, et al. Hemosuccus pancreaticus as a source of obscure upper gastrointestinal bleeding: three cases and literature review. Am J Gastroenterol. 1995;90:10Google Scholar
  7. 7.
    Maisonneuve P, Lowenfels A. Epidemiology and prospects for prevention of pancreatic cancer 2nd edn. In: Neoptolemos J, Urrutia R, Abbruzzese J, Büchler M (eds) Pancreatic cancer. New York, NY: Springer; 2017. pp 1–16Google Scholar
  8. 8.
    Cho H-W, Choi J-Y, Kim M-J, et al. Pancreatic tumors: emphasis on CT findings and pathologic classification. Korean J Radiol. 2011;12:731–9.CrossRefGoogle Scholar
  9. 9.
    Frampas E, Morla O, Regenet N, et al. A solid pancreatic mass: tumour or inflammation? Diagn Interv Imaging. 2013;94:741–55.CrossRefGoogle Scholar
  10. 10.
    Choudhary N, Puri R, Sud R. An uncommon pancreatic mass lesion is leading to recurrent gastrointestinal bleed. Endosc Ultrasound. 2014;3:252.CrossRefGoogle Scholar
  11. 11.
    Nagamatsu H, Takahashi K, Ueo T, et al. A case of splenic artery aneurysm simulating a pancreas tumor. Nihon Shokakibyo Gakkai Zasshi. 2011;108:1420–7.Google Scholar
  12. 12.
    Sayilir A, Onal IK, Beyazit Y, et al. A rare cause of upper gastrointestinal bleeding: hemosuccus pancreaticus: angiographic and endoscopic combined treatment. Surg Laparosc Endosc Percutan Tech. 2011;21:e286–7.CrossRefGoogle Scholar
  13. 13.
    Watanabe M, Nakazaki H, Tokura N, et al. Intraoperative packing of a pancreatic pseudocyst complicated with bleeding pseudoaneurysm. J Hepato Biliary Pancreat Sci. 2004;11:422–5.CrossRefGoogle Scholar
  14. 14.
    Bergert H, Hinterseher I, Kersting S, et al. Management and outcome of hemorrhage due to arterial pseudoaneurysms in pancreatitis. Surgery. 2005;137:323–8.CrossRefGoogle Scholar
  15. 15.
    Vimalraj V, Kannan DG, Sukumar R, et al. Haemosuccus pancreaticus: diagnostic and therapeutic challenges. HPB. 2009;11:345–50.CrossRefGoogle Scholar
  16. 16.
    Lermite E, Regenet N, Tuech J-J, et al. Diagnosis and treatment of hemosuccus pancreaticus: development of endovascular management. Pancreas. 2007;34:229–32.CrossRefGoogle Scholar
  17. 17.
    Barge JU, Lopera JE. Vascular complications of pancreatitis: role of interventional therapy. Korean J Radiol. 2012;13:45–55.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Gastroenterology 2018

Authors and Affiliations

  1. 1.Department of Medical Education, Leonard M. Miller School of MedicineUniversity of Miami, Miller School of MedicineMiamiUSA
  2. 2.Department of Vascular and Interventional RadiologyJackson Memorial Medical CenterMiamiUSA

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