Background and Aims Hemosuccus pancreaticus (HP) is a rare cause of upper gastrointestinal bleeding, and there are currently no recognized diagnostic and treatment standards. This study summarized the clinical characteristics of HP patients reported in the literature over the past four decades to enhance our understanding of HP, improve early recognition and diagnosis, and provide a theoretical basis for standardizing clinical diagnostic and treatment strategies.Methods The relevant literature published from January 1977 to December 2021 concerning HP was collected. The etiology, clinical manifestations, laboratory tests, imaging examinations, diagnostic and treatment methods, and prognosis of HP patients were analyzed.Results A total of 151 articles were included, comprising 333 patients, including 267 males and 66 females, with a male-to-female ratio of approximately 4∶1. The age ranged from 3 to 94 years, with an average age of 45.9 years. The most common cause was pancreatitis (82.3%), with chronic pancreatitis accounting for 89.1%, followed by peripancreatic artery aneurysm (6.0%) and pancreatic tumors (5.4%). The most common clinical manifestations were melena (74.2%) and abdominal pain (53.8%). Imaging diagnosis primarily relied on upper gastrointestinal endoscopy, contrast-enhanced abdominal CT, and celiac artery angiography. Among the 282 patients who underwent upper gastrointestinal endoscopy, 140 (49.6%) received a definitive diagnosis. Abdominal CT scans were performed in 204 cases, revealing pseudoaneurysms in 120 cases (58.8%), pseudocysts in 46 cases (22.5%), pancreatic tumors in 15 cases (7.4%), peripancreatic artery aneurysms in 13 cases (6.4%), and pancreatic duct stones in 4 cases (2.0%). Among the 193 patients who underwent celiac artery angiography, 112 (58.0%) had positive results. The most common source of bleeding was the splenic artery (41.2%), followed by the gastroduodenal artery (16.7%), bleeding from the cyst wall (9.9%), and the pancreaticoduodenal artery (9.6%). Thirty-six patients opted for conservative treatment, 180 attempted interventional treatment, 147 (81.7%) achieving success, and 140 underwent surgical treatment. Nine patients chose other treatment modalities. Follow-up results for 218 patients showed that 197 cases (91.4%) had no recurrent bleeding, 13 cases (6.0%) suffered re-bleeding, and 5 cases (2.3%) died.Conclusion The diagnosis of HP is difficult and should be based on a comprehensive assessment, including medical history and clinical presentation. Repeated imaging examinations may be necessary to improve diagnostic accuracy. Treatment should primarily target the underlying cause with a multidisciplinary approach, and the treatment choice should be based on the clinical course of the disease.