HEMORRHAGE INTO THE PANCREATIC DUCT (HEMOSUCCUS-PANCREATICUS) - RECOGNITION AND MANAGEMENT

Objective: To highlight the clinical presentation, investigation and t reatment of haemorrhage into the pancreatic duct. Design: Retrospectiv e study and review of publications. Setting: University hospital, Swit zerland. Subjects: All 4 cases from 1972 to 1993. Interventions: 2 Whi pple procedures, 1 resection of the pancreatic head, 1 exploratory lap arotomy. Radiological embolisation in one case. Main outcome measures: Cessation of haemorrhage and survival. Results: The diagnosis was mad e preoperatively in three cases by gastroduodenoscopy and arteriograph y. Operation was the primary treatment in all patients and was effecti ve with low morbidity and no mortality in three of them. Embolisation stopped the haemorrhage in the fourth patient, who was alcoholic and d ied of progressive liver insufficiency and variceal haemorrhage. Concl usions: There is no specific indication for haemorrhage into the pancr eatic duct. The diagnosis is suggested by endoscopy (absence of a more common cause, or blood in the second part of the duodenum). Arteriogr aphy is essential to confirm the site of the bleeding and to attempt e mbolization. Operation is usually the definitive treatment.