Korean J Gastroenterol.  2017 Dec;70(6):301-303. 10.4166/kjg.2017.70.6.301.

Hemosuccus Pancreaticus in the Simple Mucinous Cyst of the Pancreas

• Jo IE
• Kang DH
• Choi CW
• Kim HW
• Kim SJ
• Nam HS
• Ryu DG

• KMID: 2398881
• DOI: http://doi.org/10.4166/kjg.2017.70.6.301

Abstract

Hemosuccus pancreaticus is an unusual gastrointestinal hemorrhage through the main pancreatic duct. We report a rare case of hemosuccus pancreaticus due to a simple mucinous cyst of the pancreas. A 52-year-old man who had been followed-up for a suspected branch duct intraductal papillary mucinous neoplasm (IPMN) visited the emergency room due to hematochezia. Endoscopy showed active bleeding from the ampulla. Computed tomography revealed hemorrhage in a 2.0-cm cystic mass in the pancreatic body. The patient was diagnosed with hemosuccus pancreaticus caused by bleeding into the main pancreatic duct from suspected IPMN. Elective laparoscopic distal pancreatectomy was performed. The histopathological diagnosis was a simple mucinous cyst with squamous metaplasia based upon the pathological finding involving the absence of ovarian-type stroma. In conclusion, it should be recognized that a pancreatic cyst including simple mucinous cyst may cause hemosuccus pancreaticus, and these cysts should be viewed as neoplastic and approached similarly as other mucinous pancreatic neoplasms.

Keyword

Pancreas; Bleeding; Cysts

MeSH Terms

Diagnosis
Emergency Service, Hospital
Endoscopy
Gastrointestinal Hemorrhage
Hemorrhage
Humans
Metaplasia
Middle Aged
Mucins*
Pancreas*
Pancreatectomy
Pancreatic Cyst
Pancreatic Ducts
Pancreatic Neoplasms
Mucins

Figure

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  Fig. 1. (A) Two cystic masses in the pancreas body (0.8 cm, thick arrow) and tail (2.0 cm, thin arrow) were seen on contrast enhanced abdominal CT 8 months prior. (B) About 1.2 cm sized cystic mass in the pancreatic body, connected with main P-duct was seen on MRI (T1) after 3 months. The cystic mass at the pancreas tail was resorbed. (C) Hemorrhage in the 2.0 cm cystic mass of the pancreatic body was seen on the contrastenhanced abdominal CT. CT, computed tomography; MRI, magnetic resonance imaging.

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  Fig. 2. Blood was detected from the major papilla by esophagogastroduodenoscopy.

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  Fig. 3. (A) No papillary epithelium is seen. The normal epithelium layer is destroyed (thick arrow) (H&E, ×50). (B) Partial squamous metaplasia is seen (arrows) (H&E, ×100). (C) Mucinous epithelium without ovarian-type stroma is seen (H&E, ×200).

Reference

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