A case of haemosuccus pancreaticus

Haemosuccus pancreaticus (Wirsungorrhagia or pseudohaemobilia) is a rare complication of chronic pancreatitis. We describe a 48-year-old patient with alcohol-induced chronic calcific pancreatitis and recurrent episodes of severe upper gastrointestinal bleeding but without abdominal pain. Upper gastrointestinal endoscopy revealed fresh blood oozing from the ampulla of Vater. No pseudoaneurysms or pseudocysts were detected by arteriography or computerized tomography. The bleeding was attributed to pancreatic lithiasis. Following conservative treatment, there was no evidence of recurrence during a 24-month follow-up period. In conclusion, although a rare occurrence, haemosuccus pancreaticus should be considered in the differential diagnosis of all cases of obscure upper gastrointestinal bleeding in patients with chronic pancreatitis, whether or not accompanied by pain. A highly suggestive clinical history or X-ray findings and an endoscopic visualization of blood coming from the ampulla of Vater may suffice for the diagnosis, thus avoiding diagnostic and therapeutic errors. When haemosuccus pancreaticus occurs in patients without pseudoaneurysms or pseudocysts, it can be treated conservatively, thus obviating the need for pancreatectomy or arteriographic embolization.