A Case of Chronic Pancreatitis with Hemosuccus Pancreaticus Caused by a Microrupture of the Splenic Artery with Arteriosclerosing into the Main Pancreatic Duct

Hideaki Nezuka, Kazuhisa Yabushita, Shouzou Houjou, Masashi Inokuchi, Hideto Fujita, Seiichi Yamamoto, Masahide Kaji, Kiichi Maeda and Kohji Konishi

Department of Surgery, Toyama Prefectural Central Hospital

Hemosuccus pancreaticus-blood entering the gastrointestinal tract through the pancreatic duct is rare, and most commonly caused by a pseudoaneurysm of the splenic artery due to acute or chronic pancreatic inflammation. We report hemosuccus pancreaticus caused by a microrupture of the splenic artery with arteriosclerosis into the main pancreatic duct without aneurysms or pancreatic cystic lesions. A 79-year-old man suffering from recurrent hematemesis and melena from July 1996 consulted several hospitals but the cause of gastrointestinal bleeding was not found. In November 2001, endoscopy showed fresh bleeding from the Vaters papillae, and he was diagnosed as hemosuccus pancreaticus. Since we did not detect the hemorrhage locally in angiography near the splenic artery, he did not improve in conservative treatment, so we conducted total pancreatectomy. Histopathologically, the cause of bleeding was a microrupture of the splenic artery with arteriosclerosis into the main pancreatic duct. Hemosuccus pancreaticus is rare, but it is important to treat gastrointestinal bleeding whose origin is not immediately known.

Key words
hemosuccus pancreaticus, chronic pancreatitis, gastrointestinal bleeding

Reprint requests
Hideaki Nezuka Department of Surgery, Toyama Prefectural Central Hospital
2-2-78 Nishinagae, Toyama, 930-8550 JAPAN

Accepted
June 30, 2004

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