Hemosuccus Pancreaticus: A systematic approach

Abstract

Background and Aim: Hemosuccus pancreaticus is considered as one of the rare cause of upper gastrointestinal bleeding. Intermittent nature of bleeding and lack of standardized approach for diagnosis has resulted in significant delay in definitive management. Methods: We retrospectively analyzed prospectively maintained data of patients with suspected hemosuccus pancreaticus between January 2010 and December 2019. Results: Out of 114 patients, 87 patients were diagnosed with hemosuccus pancreaticus. Mean age was 35.7 ± 11.7 years with 89.7% men. Median duration of bleeding before diagnosis was 10 days, with 40.2%, 10.3%, and 5.7% patients had symptoms beyond 1, 6, and 12 months, respectively. Visceral artery aneurysm was noted in 62% of cases with splenic artery aneurysm (37.9%) being the common source of bleed. Rarer causes noted were superior mesenteric artery aneurysm, pancreatic adenocarcinoma, gastrointestinal stromal tumor, and post-endoscopic retrograde cholangiopancreatography (2.3% each). Santorinirrhage was seen in 3.4% patients. Endoscopic diagnosis was possible in 64.4% of patients, and angiogram localization of bleeding source was noted in 94.2%. A 56.3% of patients underwent conventional angioembolization with 95.9% success and 28.7% underwent surgery, with overall rebleeding rate of 11.5%. Conclusions: Early diagnosis of hemosuccus pancreaticus avoids prolonged suffering, multiple hospital admissions, and multiple blood transfusions. It is not uncommon in the absence of aneurysm. In cases of high suspicion, repeating the endoscopy with proper technique and proper timing increases the yield. Angioembolization remains the most preferred first line therapeutic approach in majority of cases.

Hemosuccus Pancreaticus: A Serious Complication of Chronic Pancreatitis

“…The most common presenting symptom is melena [ 5 ]. Abdominal pain is also common and can be explained by the rapid distention of the pancreatic duct by blood [ 6 ].…”

The Tale of a Bleeding Tree: A Rare Case of Peripancreatic Variceal Hemorrhage Causing Hemosuccus Pancreaticus

“…In cases where detection is challenging, a side-viewing duodenoscope can be used. A retrospective study by Yashavanth et al [ 9 ] identified overall endoscopic diagnosis to be about 64.4% in patients with HP. CECT is done to detect pseudocyst, aneurysmal lesions, and other pathologies related to the pancreas.…”

Vascular complications of pancreatitis

“…Diagnosis and evaluation of HP remain a challenge due to the vague and variable presentation of HP. A retrospective single-center study by Yashavanth et al [ 43 ] in 2021 evaluated patients with suspected HP over a 10-year period. The study showed that the median duration of bleeding prior to diagnosis was ten days, with 40.2% of patients exhibiting symptoms for > 1 mo.…”

“…The study showed that 62% of patients with HP had evidence of visceral artery aneurysms. Upper GI endoscopy showed evidence of bleeding in 64.4% of patients, and angiography was successful in localizing the source of bleeding in 94.2% of cases[ 43 ].…”