Hemosuccus pancreaticus caused by a primary splenic artery aneurysm as a rare cause of gastrointestinal bleeding: report of a case.

Hemosuccus pancreaticus is a rare complication of chronic pancreatitis. It is defined as hemorrhage from the papilla of Vater via the pancreatic duct. A 77-year-old man presented with a history of intermittent episodes of hematemesis and abdominal pain. Upper gastrointestinal endoscopy showed no obvious bleeding point, but clots were seen in the stomach and duodenum. Computed tomography (CT) showed a splenic artery aneurysm, and we diagnosed hemosuccus pancreaticus caused by rupture of the aneurysm into the main pancreatic duct. We performed distal pancreatectomy, during which we found the splenic artery aneurysm with thrombus in the pancreatic tail. Angiography of the resected specimen showed the splenic artery aneurysm and the communication with the main pancreatic duct. Microscopic examination revealed a true aneurysm of the splenic artery. Interventional radiology is commonly performed for diagnosis and treatment, but arterial embolization has a high recurrence rate. Thus, surgery is still required for hemosuccus pancreaticus.