Intra-abdominal ticking time bomb: haemosuccus pancreaticus

Abstract

A 48-year-old man presented in a near-syncopal state with a 3-day history of melaena, anaemia and epigastric pain. His medical history was significant for chronic autoimmune sclerosing pancreatitis and three previous hospitalisations for enigmatic gastrointestinal bleeding. Symptomatic treatment for anaemia was coupled with oesophagogastroduodenoscopy, two colonoscopies and video capsule endoscopy, but all failed to identify a source of gastrointestinal bleeding. CT angiography of the abdomen revealed extravasation of contrast from a small branch of the splenic artery, later identified as a splenic artery pseudoaneurysm, which was subject to two separate failed embolisation attempts. The patient eventually required a splenectomy to abate the haemorrhaging. One-month postsplenectomy, the patient was haemodynamically stable but required readmission due to significant epigastric abdominal pain secondary to acute exacerbation of pancreatitis.