Pancreaticoduodenal Artery and Superior Mesenteric Artery Pseudoaneurysm Associated With Hemosuccus Pancreaticus

A 24-year-old man who underwent a second partial gastrectomy was admitted to our hospital with gastrointestinal (GI) bleeding. In autumn 2005, he had several episodes of GI bleeding after epigastric intermittent pain. There were 1 or 2 attacks every year. Three years later, he suddenly vomited about 1000 mL blood on a bus and was sent to a hospital; his hemoglobin had dropped to 40 g/L. One month later, he underwent first partial gastrectomy for duodenal bulb ulcer associated with active bleeding. Then the second gastrectomy was performed for 2 episodes of anastomotic ulcer bleeding in December 2008. On February 4, 2009, he had hematemesis again. Computed tomography (CT) scanning showed splenomegaly and signs of portal hypertension, and magnetic resonance cholangiopancreatography (MRCP) image revealed normal biliary tract and pancreas. On March 9, he was admitted to our hospital; the serum gastrin and amylase levels were normal. MRCP image showed normal common bile duct. CT scanning revealed a slightly distended pancreatic tube and a normal size pancreas.