A case of haemosuccus pancreaticus

Haemosuccus pancreaticus (Wirsungorrhagia or pseudohaemobilia) is a rare co mplication of chronic pancreatitis. We describe a 48-year-old patient with alcohol-induced chronic calcific pancreatitis and recurrent episodes of sev ere upper gastrointestinal bleeding but without abdominal pain, Upper gastr ointestinal endoscopy revealed fresh blood oozing from the ampulla of Vater . No pseudoaneurysms or pseudocysts were detected by arteriography or compu terized tomography, The bleeding was attributed to pancreatic lithiasis, Fo llowing conservative treatment, there was no evidence of recurrence during a 24-month follow-up period. In conclusion, although a rare occurrence, hae mosuccus pancreaticus should be considered in the differential diagnosis of all cases of obscure upper gastrointestinal bleeding in patients with chro nic pancreatitis, whether or not accompanied by pain, A highly suggestive c linical history or X-ray findings and an endoscopic visualization of blood coming from the ampulla of Vater may suffice for the diagnosis, thus avoidi ng diagnostic and therapeutic errors. When haemosuccus pancreaticus occurs in patients without pseudoaneurysms or pseudocysts, it can be treated conse rvatively, thus obviating the need for pancreatectomy or arteriographic emb olization. (C) 2000 Lippincott Williams & Wilkins.