Hemosuccus pancreaticus in paediatric patients: unmasking the concealed haemorrhage of the pancreas by contemplating beyond endoscopy

Hemosuccus pancreaticus represents an exceedingly rare aetiology of gastrointestinal haemorrhage in the paediatric population, characterised by bleeding emanating from the ampulla of Vater via the pancreatic duct. Its infrequency results in limited data regarding its incidence and management in children. The diagnosis is challenging due to its uncommon occurrence and the concealed nature of the bleeding source, which is frequently overlooked during endoscopic examination. We present three paediatric cases presenting with melena and pancreatitis. Although endoscopy yielded negative results, CT angiography identified haemorrhage originating from pseudoaneurysms of the left gastric, right gastric and splenic arteries, which were subsequently managed with endovascular embolisation. Therefore, hemosuccus pancreaticus should be considered in the differential diagnosis of paediatric patients with pancreatitis and gastrointestinal bleeding, even when endoscopic findings are unremarkable; cross-sectional imaging is essential. The minimally invasive modality of endovascular treatment offers advantages, including reduced morbidity and expedited recovery.