Endovascular management of hemosuccus pancreaticus secondary to splenic artery pseudoaneurysm: a case report.

BACKGROUND

Hemosuccus pancreaticus (HP) is a rare cause of gastrointestinal bleeding, characterized by the pathological passage of blood from the pancreatic duct into the duodenum via the ampulla of Vater. HP presents considerable diagnostic and therapeutic challenges due to its nonspecific clinical presentation and the intermittent nature of bleeding.

CASE DESCRIPTION: A 62-year-old male with no history of pancreatitis, abdominal trauma, or surgery presented with recurrent abdominal pain and hematochezia over 3 months, acutely worsening in 72 hours. Initial evaluation revealed severe anemia (hemoglobin 5.4 g/dL) and a 2.2 cm × 2.0 cm saccular splenic artery pseudoaneurysm (SAP) without active extravasation on computed tomography (CT). Despite transfusion (hemoglobin transiently improved to 7.8 g/dL), the patient experienced recurrent hematochezia and subsequent hematemesis. Angiography confirmed the SAP but showed no active extravasation; endoscopy failed to identify the bleeding source. Upon transfer due to hemodynamic deterioration (hemoglobin 4.0 g/dL), emergency CT revealed a 2.8 cm × 2.3 cm proximal SAP with active contrast extravasation into the descending duodenum. This finding, together with endoscopic visualization of bleeding from the ampulla, strongly supported the diagnosis of HP secondary to the SAP. The patient underwent successful endovascular embolization using the "sandwich" technique with Amplatzer vascular plugs (AVPs) and microcoils.

CONCLUSIONS

This case underscores the diagnostic difficulty of HP, especially when initial imaging shows no active bleeding. A high index of suspicion is warranted in patients with obscure recurrent gastrointestinal bleeding, particularly in the presence of a known SAP. Timely diagnosis relies on multimodal imaging, including contrast-enhanced CT, endoscopy, and angiography. Endovascular embolization offers a safe, minimally invasive, and effective therapeutic option.