[Hemosuccus pancreaticus caused by pancreatic cancer treated with radiation therapy for hemostasis]

A 67-year-old female patient, with a chief complaint of melena, was referred to our hospital because of a pancreatic tumor. A blood assessment revealed anemia with a hemoglobin (Hb) level of 7.7g/dL. Contrast-enhanced computed tomography (CT) detected a large pancreatic tail tumor and liver metastasis. Upper endoscopy demonstrated bile juice containing a blood-like red in the duodenum. We confirmed the pancreatic cancer diagnosis via endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). CT after the procedure indicated a hematoma in the pancreatic tumor. The patient required frequent blood transfusions due to severe anemia. The second upper endoscopy demonstrated bleeding from the papilla of Vater. We diagnosed the patient with hemosuccus pancreaticus (HP). Pancreatic cancer, not hematoma, was considered to cause HP because we detected blood, such as red bile juice, before EUS-FNA. Her Hb levels decreased although she underwent coil embolization of the left gastric artery and splenic artery branches. We considered surgical treatment to stop the bleeding, but we abandoned surgery because of the pancreatic cancer invasion of the surrounding organs. We then attempted radiation therapy. Her Hb level stopped decreasing following treatment. She did not need frequent blood transfusions until she received radiation therapy and died 3 months later. The autopsy revealed a final diagnosis of anaplastic carcinoma. HP is an uncommon disease caused by bleeding from the papilla of Vater. HP is frequently caused by chronic pancreatitis, but it is also induced by a pancreatic tumor. Most HP cases received interventional radiology and surgical treatment. Here, we describe a case of HP caused by pancreatic cancer in which radiation therapy was effective for hemostasis.