Introduction. Neuroendocrine tumors have variable presentation. Hemosuccus entericus(HE) as a clinical sign is rare and NET presenting as bleeding through papilla is a remote possibility.
Materials : 22 yrs female otherwise fit and healthy with dyspeptic symptoms of 12 months duration,presented to the gastroenterologist with upper abdominal pain with anemia. An OGD revealed blood oozing from the papilla -Hemosuccus Entericus. Contrast enhanced CT revealed a cystic lesion in the tail of pancreas compressing the splenic vein causing sectoral portal hypertension. An angiogram was done and attempted embolisation for what it thought to be Splenic Artery Pseudoaneurysm. Though hemo-dynamically stable, there was slow drop in Hemoglobin. Laparotomy done and distal pancreatectomy with spleen performed. Post operative recovery was uneventful.
Result: Nodular mass 5.5x 4 x 3.5 cm , grey white to grey brown. Tumor cells arranged in nests and papillary pattern with mitotic figures 0-1/HPF. Nuclear grade 2.
Conclusion: The final diagnosis is Pancreatic Neuroendocrine carcinoma with capsular infiltration