Acute Necrotizing Pancreatitis Leading to Hemosuccus Pancreaticus and Hemorrhagic Shock in the Setting of Decompensated Cirrhosis

Hemosuccus pancreaticus (HP) is a rare, life-threatening cause of upper gastrointestinal bleeding, often linked to chronic pancreatitis and pseudoaneurysm rupture into the pancreatic duct. However, its occurrence in acute necrotizing pancreatitis with decompensated cirrhosis is exceedingly rare and poses significant diagnostic and treatment challenges. We report a case of a 34-year-old male with decompensated alcoholic cirrhosis who developed hemorrhagic shock from HP following acute necrotizing pancreatitis. The initial imaging revealed a pancreatic tail hematoma and a splenic artery pseudoaneurysm, that was later found to have ruptured into the pancreatic duct, causing intermittent GI bleeding. Endoscopy showed clots extruding from the ampulla, and angiography confirmed active bleeding, leading to endovascular coil embolization. Despite intervention, the patient's coagulopathy and hemodynamic instability, related to his cirrhosis, worsened, ultimately resulting in death under comfort care. This case underscores the importance of considering HP in patients with pancreatic disease and unexplained GI bleeding, especially in the presence of pseudoaneurysms, as timely endovascular or surgical management, coupled with a multidisciplinary approach, is essential to improve outcomes.