Hemosuccus pancreaticus after endoscopic ultrasound-guided fine needle aspiration of a pancreatic cyst.

scopic ultrasound (EUS) evaluation of a cystic lesion in the pancreas tail, which had been found on cross-sectional imaging during work-up of unintended weight loss. A 4.7 × 4.5 cm anechoic, septated macrocystic lesion was seen in the pancreas tail with a central calcification (●" Fig. 1). The remainder of the pancreas examination was normal. An avascular pathway was chosen and a 19-gauge needle was advanced into a large cystic component for fine needle aspiration (FNA). A frankly bloody aspirate was seen. Repeat EUS-FNA of a separate component of the cyst yielded slightly viscous, clear, nonbloody fluid, which was sent for analysis. The echoendoscope was then readvanced into the second portion of duodenum, demonstrating fresh blood emanating from the papilla (●" Fig. 2). With the echoendoscope in the second portion of the duodenum, endosonographic evaluation of the pancreatic duct revealed a hyperechoic filling defect consistent with blood (●" Fig. 3). The patient was admitted overnight for observation after developing mild, self-resolving pancreatitis, but she did not need further therapy. Histologic examination of the surgically resected cyst demonstrated a benign serous cystadenoma. EUS-FNA is a procedure with a well-described low complication rate [1]. Intracystic bleeding after EUS-FNA can occur, however, and rarely may result in hemosuccus pancreaticus [2,3]. A 19-gauge FNA needle was used for cyst aspiration in the present case, which may possibly contribute to this complication. In this case conservative management resulted in complete resolution.