HEMOSUCCUS PANCREATICUS FROM A SPLENIC ARTERY PSEUDOANEURYSM - AN UNUSUAL CAUSE OF UPPER GASTROINTESTINAL-BLEEDING

Hemorrhage through the pancreatic duct into the duodenum, so called '' hemosuccus pancreaticus'', is a rare cause of gastrointestinal bleedin g with diagnostic difficulties. We report a 60-year-old man with recur rent upper gastrointestinal bleeding due to rupture of a splenic arter y pseudoaneurysm into the pancreatic duct. Initial upper gastrointesti nal endoscopy failed to identify the site of the hemorrhage. Abdominal computed tomography disclosed a cystic mass containing a well-enhance d spherical area at the pancreatic tail. Arterial blood flow was demon strated in the lesion by Doppler ultrasound. Celiac angiography pseudo aneurysm arising from the splenic artery. Bleed located in a big duode nal diverticulum was found on repeat endoscopy. Surgical resection of the pseudoaneurysm with distal pancreatectomy and splenectomy was succ essfully performed. The patient remained symptom-free 5 months after t he operation. Hemosuccus pancreaticus, although rare, remains importan t in the differential diagnosis of upper gastrointestinal bleeding of obscure origin.