1. Review of haemosuccus pancreaticus pathology and presentation of a case study 2. Discussion of the role of radiology in diagnosis and management of haemosuccus pancreaticus

Haemosuccus pancreaticus is a rare cause of upper gastrointestinal haemorrhage characterised by bleeding through the duodenal ampulla via the pancreatic duct. It is estimated to be the underlying aetiology in only one out of every 1500 cases of upper gastrointestinal bleeding, with approximately 150 cases reported in the literature since Lower and Farell first described the disease in 1931. 1-3 The condition is most commonly seen in patients with acute or chronic pancreatitis. The most common mechanisms are due to haemorrhage into a pancreatic pseudocyst...

The diagnosis of haemosuccus pancreaticus relies on clinical evaluation, upper gastrointestinal endoscopy and medical imaging. Endoscopy is essential to rule out other causes of upper gastrointestinal bleeding. Bleeding from the ampulla may be visualised, confirming either haemobilia or haemosuccus pancreaticus. As demonstrated in previous series, a negative endoscopy is present in 70% of cases. 5,7,8 Medical imaging plays an integral role in the diagnosis of haemosuccus pancreaticus. Contrast enhanced computed tomography is the most valuable first line radiological modality as it demonstrates pancreatic pseudocyst and...

Radiology has an integral role in the diagnosis and management of haemosuccus pancreaticus. CT angiography and invasive angiography remain the central modalities in the diagnostic process, with angiography offering an effective means of first line management.

Doctor Henry Smith is a current Junior House Officer at the Townsville Hospital. Miss Bridget Boles is a final year medical student also at the Townsville Hospital. Both are local to Townsville and are interested in radiology. Thanks to Dr Archana Dwivedee, an interventional radiologist at the Townsville Hospital. Dr Dwivedee was invovled in the case and assisted with the poster.

Yu P, Gong J. Hemosuccus pancreaticus: A mini-review. Annals of medicine and surgery. 2018 April; 28: 45-48. Suter M, Doenz F, Chapuis G, et al. Haemorrhage into the pancreatic duct (Hemosuccus pancreaticus): recognition and management. The European journal of surgery. 1995 Dec; 61 (12): 887-92. Rammohan A, Palaniappan R, Ramaswami, et al. Hemosuccus Pancreaticus: 15-Year Experience from a Tertiary Care GI Bleed Centre. ISRN radiology. 2013 Feb 28: 2013:191794 Aiden M. Callinan, Jaswinder S, et al. Hemosuccus pancreaticus. ANZ Journal of Surgery. 2004 May 17;74...