Pancreatoduodenectomy for hemosuccus pancreaticus in silent chronic pancreatitis.

Hemorrhage is an infrequent but known complication of chronic pancreatitis. The pathogenesis of spontaneous bleeding includes splenic vein thrombosis, pancreatic lithiasis, and erosion of a pseudocyst into vessels incorporated in its wall. Bleeding may occur into the gastrointestinal tract, the peritoneal cavity, or retroperitoneum. Moreover, bleeding can be severe, with rapid development of shock, or mild in patients who have exhibited minimal clinical symptoms. "Hemosuccus pancreaticus" is the term coined to describe the rare case of bleeding observed to occur through the ampulla of Vater. Exceedingly rare, as was the case in our patient, is when hemosuccus pancreaticus is due to a bleeding pseudocyst of the head of the pancreas in the absence of gastrointestinal blood loss as well as abdominal pain.