• Yoshikazu Toyoki, Kenichi Hakamada, Shunji Narumi, Masaki Nara, Keinosuke Ishido, and Mutsuo Sasaki.
• Department of Gastroenterological Surgery, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, Japan. ytoyoki@cc.hirosaki-u.ac.jp
• World J Gastroentero. 2008 May 7;14(17):2776-9.

AbstractHemosuccus pancreaticus is a rare cause of intermittent upper gastrointestinal bleeding. We report two cases of hemosuccus pancreaticus with multiple episodes of upper gastrointestinal bleeding. The causes of hemorrhage were rupture of pseudoaneurysm of the splenic artery and bleeding from the wall of pancreatic pseudocyst. Interventional radiology is the first modality for early diagnosis and possible treatment of hemosuccus pancreaticus. When angiography shows no abnormal findings or interventional radiological therapy can not be successful, surgery should be considered without delay. Our patients herein underwent surgery without recurrence or sequelae. Intraoperative ultrasonography and pancreatoscopy were helpful modalities for confirming the source of hemorrhage and determining the cutting line of the pancreas. When we encounter intermittent upper gastrointestinal bleeding with an obscure source, hemosuccus pancreaticus should be included in differential diagnoses especially in patients with chronic pancreatitis, which would lead to a prompt and proper treatment.

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