Hemosuccus pancreaticus from a splenic artery pseudoaneurysm as a rare cause of gastrointestinal bleeding: a case report

Introduction and importance: Hemosuccus pancreaticus (HP) is a life-threatening diagnostic challenge due to the relative rarity of the disease. We report a patient with an unknown cause of an upper gastrointestinal bleed (UGI), who was incidentally found to have HP on esophagogastroduodenoscopy (EGD) caused by a large splenic artery pseudoaneurysm. Timely diagnosis and emergent management are required to prevent catastrophic complications. Presentation of case: An 87-year-old male with a history of alcohol use and recurrent gastrointestinal (GI) bleeds secondary to arteriovenous malformations presented with a GI bleed. Computed tomography angiography (CTA) showed no active hemorrhage but did reveal a 4.0 cm fusiform pseudoaneurysmal dilation of the splenic artery. EGD revealed active bleeding from the ampulla. Due to a high suspicion of a fistulous connection between the pseudoaneurysm and the pancreatic duct, the patient underwent successful embolization. Clinical discussion: In reported cases of HP secondary to a visceral artery pseudoaneurysm, most patients have a prior diagnosis of acute or chronic pancreatitis. While our patient did have a history of alcohol use, clinically, he exhibited no symptoms or history of pancreatitis, thus contributing to the diagnostic challenge of the case. Conclusion: A high index of suspicion is required to consider HP as a cause of an acute UGI bleed in a patient with visceral pseudoaneurysms found on imaging, without a prior diagnosis of pancreatitis. These patients have a high risk of mortality and require urgent CTA for timely diagnosis. Management requires multidisciplinary discussion between gastroenterology, hepatobiliary surgery, and interventional radiology, as the two main therapeutic modalities include embolization or surgery.