Bleeding into the pancreatic duct (haemosuccus pancreaticus), a rare complication of pancreatitis

History and admission findings: A 41-year-old man was admitted because of r ecurrent tarry stools and dizziness. Chronic pancreatits induced by alcohol ism was known. The main abnormal laboratory finding was anaemia (haemoglobi n 4.6 g/dl, erythrocytes 2.28/fl). Investigations, treatment: and course: At endoscopy of the oesophagus, stom ach and duodenum, fresh blood was found in the duodenum, a small trickle of blood coming from the papilla of Vater. Endoscopic retrograde cholangiogra phy discovered no abnormality in the biliary system. Selective contrast ima ging of the pancreatic duct demonstrated a short prepapillary stenosis and a prestenotic dilatation (up to 15 mm diameter) of the pancreatic duct with a cloudy contrast filling defect. After catheter withdrawal from the pancr eatic duct blood spurted from the papilla. Emergency angiography revealed p seudoaneurysmatic dilatation of the gastroduodenal artery in the region of the head of the pancreas. At selective catheterization this artery was succ essfully occluded with metal coils placed both proximally and distally to t he source of bleeding. Conclusion: Gastrointestinal bleeding is a rare but potentially life-threat ening complication of pancreatitis. When searching for bleeding in the uppe r gastrointestinal tract, the papilla of Vater should be looked for as a po ssible source. Bleeding from the pancreas occurs particularly in pancreatit is, pancreatic pseudocyst or pancreatic tumour.