An Atypical Presentation of Hemosuccus Pancreaticus Manifesting as Hematochezia

Abstract

Hemosuccus pancreaticus is a rare cause of upper gastrointestinal bleeding that is often associated with chronic pancreatitis. The bleeding usually manifests as melena because the source originates superior to the ligament of Treitz. We present a patient who was admitted for acute-on-chronic pancreatitis and ultimately developed hematochezia. Endoscopy revealed active oozing at the minor duodenal papilla. Computed tomography angiography identified active contrast extravasation at the gastroduodenal artery, and it was managed successfully with angioembolization. Our case emphasizes clinicians to consider hemosuccus pancreaticus as an alternative differential in a patient with a history of chronic pancreatitis manifesting with hematochezia.One week after the endoscopy, the patient developed multiple episodes of bright red blood per rectum. Her hemoglobin dropped to 6.9, which was below her baseline of 9 g/dL. Colonoscopy performed because of suspected lower GI bleeding only revealed polyps and