Hemosuccus pancreaticus due to intraductal papillary-mucinous carcinoma of the pancreas

Abstract

A 72-year-old female was referred to our hospital for evaluation of a hyperechoic mass in the pancreatic head with ultrasound sonography. She had no symptom expect slight anemia (Hb 11.3 g/dl). On endoscopy, blood was expelled from the orifice of the major duodenal papilla, but excretion of mucus was not detected. Endoscopic retrograde pancreatography revealed an irregular defect in the main pancreatic duct at the head of the pancreas. Computed tomography revealed a 2-cm mass with a low density lesion in the pancreas head. On suspicion of malignant tumor of the pancreas, pylorus-preserving pancreaticoduodenectomy was performed. Histological diagnosis was intraductal papillary-mucinous carcinoma without mucin hypersecretion. It grew within the inferior branch of the main pancreatic duct, and the top of the tumor stood out into the main pancreatic duct. As the causes of hemosuccus pancreaticus, pancreatic benign diseases, for example, chronic pancreatitis, pseudocyst, arterial aneurysm and pseudoaneurysm, are known, but pancreatic tumors are rare. In particular, this may be the first report of hemosuccus pancreaticus induced by intraductal papillary-mucinous carcinoma of the pancreas without mucin hypersecretion.

Successful Management of Hemosuccus Pancreaticus due to Pancreatic Adenocarcinoma by Chemoradiotherapy

“…Middleaged men with a history of alcohol abuse have multiple risk factors, and chronic pancreatitis is presumed to be an underlying disease, with pseudoaneurysm and cyst potentially occurring in the setting of inflammation. However, 10 cases of hemorrhaging from tumors, similar to the present case, were found in PubMed using the keywords 'hemosuccus pancreaticus' and 'carcinoma' (Table 2) (5)(6)(7)(8)(9)(10)(11)(12)(13)(14). In particular, neoplastic HP is frequently reported in undifferentiated carcinoma, anaplastic pancreatic carcinoma, and vascular-rich tumors.…”

Hemosuccus Pancreaticus: A Great Masquerader in Patients with Upper Gastrointestinal Bleeding

“…Pseudocysts erode the arterial wall as a result of chronic inflammatory injury and become pseudoaneurysms. In approximately 10% of cases of chronic pancreatitis, pseudoaneurysms and aneurysms rupture and bleed into the pancreatic duct through fistulous tracts [9,10]. The common and uncommon associations of hemosuccus pancreaticus have been summarized in Table 2.…”

Hemosuccus Pancreaticus following a Puestow Procedure in a Patient with Chronic Pancreatitis

“…Hemosuccus pancreaticus has been shown to be the cause of underlying chronic pancreatitis in more than 80% of pancreatic diseases [ 3 ]. Other pancreatic causes of hemosuccus pancreaticus are rare and include neuroendocrine tumors [ 5 ], ectopic pancreas [ 6 ], pancreas divisum [ 7 ], and intraductal papillary-mucinous carcinomas [ 8 ]. In chronic pancreatitis, this disease is usually caused by the rupture of a pseudoaneurysm in a peripancreatic artery to the pancreatic duct or by hemorrhage of a peripancreatic artery into the pseudocyst communicating with the pancreatic duct.…”