A Case of Pancreatic Pseudocyst Complicated with Intraperitoneal Hemorrhage

Michiya Kobayashi, Takuro Ogata, Keijiro Araki, Kimio Matsuura, Shinichi Hamada, Shinya Yamamoto, Toru Ando

First Department of Surgery, Kochi Medical School

A case of intraperitoneal hemorrhage caused by rupture of a pseudoaneurysm into the pancreatic pseudocyst is reported. An 84-year-old man was admitted to a hospital complaining of sudden left flank pain and nausea. He had been in shock, but recovered with conservative therapy. Peritoneocentesis revealed intraperitoneal hemorrhage. He developed shock twice after that, and was sent to our department. Although he recovered from the shock, he complained of abdominal distension and tenderness in the whole abdomen. Laboratory data on admission showed severe anemia, hyperglycemia, and hypoproteinemia; however, serum amylase and tumor marker levels were normal. Abdominal ultrasonography and computed tomography demonstrated the massive ascites and mass at the tail of the pancreas. Celiac angiography revealed the extravasation and pooling of the contrast medium in the splenic artery. Bleeding to the pancreatic pseudocyst was diagnosed and he underwent emergency laparotomy. Laparotomy demonstrated 2000 ml of bloody ascites and a mass measuring 10 cm in diameter in the tail of the pancreas. The mass contained coagulation. He underwent distal pancreatectomy and splenectomy. The seven reported cases of ruptured pancreatic pseudocysts are also discussed.

Key words
pancreatic pseudocyst, intraabdominal bleeding, bleeding into the pacreas pseudocyst

Reprint requests
Michiya Kobayashi First Department of Surgery, Kochi Medical School
Oko-cho, Nankoku, 783 JAPAN

Accepted
December 8, 1993

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