Hemosuccus pancreaticus:: a rare cause of gastrointestinal bleeding -: A series of 9 cases

Aim - The purpose of this study was to analyze the diagnostic and therapeutic features of hemosuccus pancreaticus. Methods - We conducted a retrospective study of nine patients (eight men and one woman, mean age 60 yrs) admitted to surgery or gastroenterology units for hemossucus pancreaticus between 1981 and 2003. The following were studied: symptoms, contribution of established morphologic exams (upper digestive endoscopy, computed tomography (CT) and selective digestive angiography) and treatment. Results - Hemosuccus; pancreaticus occurred in chronic alcoholic pancreatitis (N=8) and chronic familial pancreatitis (N=1). Seven patients (77.8%) presented overt digestive bleeding (one melena, two hematochezia, two melena with hematochezia, one hematemesis, one hemorrhagic shock). The inaugural sign was anemia in one patient and epigastric pain in another. An upper digestive endoscopy, performed in eight patients (88.9%), revealed fresh red blood in the first or second duodenum in three and hemossucus pancreaticus in three others. Arteriography was performed in eight patients (88.9%) and CT angiography in one. Surgery was performed in 5 patients (55.6%), after embolization in one. Embolization was effective in 3 patients. Therapeutic abstention proved successful in one patient. There were no deaths. Conclusions - Hemosuccus pancreaticus is a rare cause of digestive bleeding. Upper digestive endoscopy and selective digestive angiography during active bleeding can provide the diagnosis. Endovascular treatment can control an unstable hemodynamic situation before elective surgery to prevent recurrence, which can be more severe than the first event.