Hemosuccus pancreaticus as a source of obscure upper gastrointestinal bleeding : three cases and literature review

We report three patients with chronic pancreatitis and recurrent episodes of severe upper gastrointestinal bleeding caused by hemosuccus pancreaticus. No bleeding source could be identified despite repeated endoscopies. In two patients, angiography disclosed a fistula between a peripancreatic artery and a pancreatic pseudocyst. In one patient, a fistula between the splenic artery and the pancreatic duct was found intraoperatively. No rebleeding occurred after operation. In cases of obscure upper gastrointestinal hemorrhage, the pancreas should be considered as a bleeding source, especially in patients with chronic pancreatitis.