Haemosuccus Pancreaticus Caused by Splenic Artery Aneurysm Derived from Isolated Spontaneous Coeliac Artery Dissection: Two Case Reports

Abstract

Objective: Two cases of haemosuccus pancreaticus (HP), a rare cause of gastrointestinal bleeding caused by splenic artery aneurysm derived from isolated spontaneous coeliac artery dissection (ISCAD), are reported. Case report: The first case was a 62-year-old man with a history of hypertension who presented with abdominal pain and melaena. Laboratory tests indicated slight anaemia and a high serum amylase level. Computed tomography (CT) showed coeliac artery dissection and a splenic aneurysm. Endoscopic retrograde cholangiopancreatography suggested a communication between the main pancreatic duct and the aneurysm. A laparoscopic distal pancreatectomy was performed. The second case was a 49-year-old man who had been followed up with coeliac artery dissection and a splenic aneurysm, and developed abdominal pain, haematemesis, and melaena. CT did not show degeneration of the coeliac and splenic lesions, and multiple endoscopies failed to detect the source of bleeding. However, the patient was clinically diagnosed with HP and had a successful transcatheter arterial embolisation. There was no recurrence in either case. Conclusion: HP should be considered in cases with adjacent splenic aneurysms, especially under fragile arterial conditions such as ISCAD.

Keywords

• Abdominal pain
• Case report
• Haemosuccus pancreaticus
• Isolated spontaneous coeliac artery dissection
• Melaena
• Splenic aneurysm