Successful Surgical Treatment of Hemosuccus Pancreaticus Caused by Rupture of a Transverse Pancreatic Artery Aneurysm: A Case Report

TL;DR

A rare case of a pancreatic artery aneurysm causing repeated bleeding was successfully treated with surgery after diagnostic challenges.

Contribution

This case report highlights the successful surgical management of a transverse pancreatic artery pseudoaneurysm causing obscure gastrointestinal bleeding.

Findings

A 49-year-old male with chronic pancreatitis had a transverse pancreatic artery pseudoaneurysm causing recurrent bleeding.

Coil embolization failed due to anatomical complexity, but emergency surgery resolved the issue with no recurrence at 6 months.

Early angiographic investigation and surgical intervention are critical for managing such rare pseudoaneurysms.

Abstract

A pancreatic pseudoaneurysm is a rare but potentially life-threatening complication of pancreatitis. Although pseudoaneurysms typically arise from the splenic, gastroduodenal, or pancreaticoduodenal arteries, transverse pancreatic artery involvement is uncommon. Here, we report the case of a pseudoaneurysm in the transverse pancreatic artery that presented with repeated episodes of obscure gastrointestinal bleeding over an extended period, with a clinical course suggestive of pancreatic duct rupture.

A 49-year-old male with chronic alcohol-related pancreatitis was brought to our hospital via ambulance because of abdominal pain and lower gastrointestinal bleeding. He had a history of recurrent obscure gastrointestinal bleeding for >11 years, with no source identified despite repeated upper and lower endoscopies, capsule endoscopy, and double-balloon enteroscopy. On admission, the patient was hemodynamically stable and had mild anemia. Contrast-enhanced CT revealed pancreatic calcifications, and upper endoscopy revealed bleeding from the major duodenal papilla. Angiography revealed a pseudoaneurysm in a tortuous branch of the transverse pancreatic artery. Coil embolization was attempted but could not be completed due to anatomical complexity. Rebleeding occurred during the procedure, prompting an emergency distal pancreatectomy and splenectomy. Surgical resection was achieved, and the patient recovered uneventfully with no recurrent bleeding at 6 months of follow-up.

Although rare, pseudoaneurysms arising from the transverse pancreatic artery can cause life-threatening hemorrhages in the pancreatic duct. In such cases, early recognition, prompt angiographic investigation, and appropriate surgical intervention are critical for successful management.

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