Sequential pancreatic ascites and hemosuccus pancreaticus from an identical rupture site in branch-duct IPMN: A Case Report

Introduction: A 68-year-old man with branch-duct intraductal papillary mucinous neoplasm (IPMN) in the pancreatic head presented with pancreatic ascites due to main duct rupture in the pancreatic body without typical pancreatitis symptoms. Case Presentation: Although the serum amylase level was elevated, the amylase level in the ascitic fluid was markedly higher. We hypothesize that mucin-induced downstream obstruction may have contributed to elevated intraductal pressure and upstream rupture. After conservative management, the patient developed delayed hemorrhage of approximately 4 months from the same site. Conclusion: Based on a PubMed literature search, this appears to be the first reported case of pancreatic ascites followed by delayed hemorrhage from the same site associated with branch-duct IPMN.