Hemosuccus Pancreaticus

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StatPearls [Internet]


Gastrointestinal bleeding (GI) is a common medical condition with high patient morbidity and mortality, which exerts a high burden on the medical care Systems. Many Pathologies might cause Gastrointestinal Bleeding, which can be categorized based on anatomical or pathophysiological factors. More frequent GI bleeding etiologies, including peptic ulcers, hemorrhoids, esophagitis, esophageal tears, esophageal varices, inflammatory bowel disease, polyps, diverticulitis, colon cancer, and many others. Other rare diseases such as hemosuccus pancreaticus (HP), hemobilia, aortoenteric fistula are also potential etiologies.

Hemosuccus pancreaticus is an extremely rare cause of gastrointestinal bleeding. It is described as a hemorrhage from the ampulla of Vater passing through the main pancreatic duct toward the second portion of the duodenum. Rarely, HP channeled into the accessory pancreatic duct toward the minor duodenal papillae. The first reported case was in 1931 by Lower and Farell, who described a patient with a rupture of the primary splenic artery into the main pancreatic duct, while HP was named and fully explained by Philip Sandholm in 1970 after he reported three cases of rupture pseudoaneurysm into the pancreatic duct.

Clinically, bleeding could be mild or severe, leading to hypovolemic shock and death. It is often difficult to be diagnosed at early stages due to the paucity of cases, anatomic location, and intermittent nature of bleeding. The unfamiliarity of HP to the physicians makes it a diagnostic challenge. It must be considered in patients with a history of chronic pancreatitis presenting with acute GI bleeding onset.

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