Hemosuccus pancreaticus: Problems and pitfalls in diagnosis and treatment

Figure 1 Case 1. Pseudoaneurysm of splenic artery communicating with pancreatic duct. A: Endoscopy reveals bleeding from papilla of Vater; B: CT scan shows a cystic mass at tail of pancreas; C: Angiography identifies aneurysms at distal portion of splenic artery and right hepatic artery (arrow); D: Operative ultrasonography demonstrates a low echoic mass at body of pancreas suspected as a hematoma (arrow).

Figure 2 Histology of Case 1. A: Pancreatic parenchyma; B: Wall of pseudoaneurysm of splenic artery; C: Orifice of pseudoaneurysm into pancreatic duct; D: Hematoma.

Figure 3 Case 2. Pseudoaneurysm in pancreatic pseudocyst. A: Angiography failed to detect a bleeding point; B: CT scan shows multiple calcifications at the whole pancreas and dilatation of main pancreatic duct; C: Endoscopic retrograde pancreatography displays a dilatated branch of pancreatic duct at head of pancreas (arrow); D: Endoscopy reveals bleeding from papilla of Vater.

Figure 4 Case 2. Intraoperative pancreatoscopy and specimen. A: Pancreatic head by pancreatoscopy; B: Pancreatic tail by pancreatoscopy, and bleeding source was seen; C: Bleeding source at pancreatic tail.