Hemosuccus pancreaticus: an in-motion endoscopic ultrasound view

A 77-year-old man was transferred to our institution due to gastrointestinal (GI) bleeding of unknown origin. Bleeding had caused permanent melena during the preceding month, with consequent severe anemia (up to 5.3 g/dL hemoglobin) requiring blood transfusion. Because of his cardiovascular comorbidities (cardiopathy, atrial fibrillation, and type II diabetes), the patient was on anticoagulation therapy, which was paused after GI bleeding started. During his previous hospital stay at another institution, the patient underwent computed tomography scan, gastroscopy, colonoscopy, magnetic resonance imaging, magnetic resonance cholangiopancreatography, endoscopic ultrasound (EUS), and red blood cell scintigraphy. Despite these procedures, the site of GI bleeding was not clear, showing only diffuse blood in the duodenum and a suspected hypoechoic pancreatic area on EUS. Laboratory tests were normal, and neoplastic biomarkers were within the normal range.