Hemosuccus Pancreaticus with Superior Mesenteric Artery Branch Pseudoaneurysm

Introduction: Hemosuccus pancreaticus is a rare cause of gastrointestinal bleeding due to hemorrhage into the pancreatic duct, most commonly from pseudoaneurysms. Due to its rarity as well as the intermittent nature of the bleeding, diagnosis is commonly delayed. We report an interesting case of hemosuccus pancreaticus and the associated management issues. Case Report: We report a 32 year old man with 3 weeks of progressive melena found to have hemosuccus pancreaticus from an superior mesenteric artery branch pseudoaneurysm as a sequela of pancreatitis. The diagnosis was made with a combination of upper endoscopy, CT angiography. Ultimately this proved to be a management challenge as it required multiple angiographic embolizations to achieve hemostasis. Discussion: Hemosuccus pancreaticus was first coined by Sandblom in 1970. As it presents as gastrointestinal hemorrhage, initial workup is the same, with upper/lower endoscopy and CT angiographies as first line methods. Visceral angiography remains the gold standard for diagnosis of aneurysmal causes. Interventional angiography is the first line treatment of hemosuccus pancreaticus. However if this fails, operative intervention with vessel ligation or formal resection may be required for hemostasis.