A Case Report of Hemorrhagic Pancreatic Pseudocyst Fenestrated into the Stomach

Kanji Ishihara, Tadashi Yamada, Norio Suzuki, Masataka Eirai, Akira Aki, Masahiro Nishikawa and Hirokazu Fujii

Department of Surgery, Ishikiriseiki Hospital

A 34-year-old man who has a history of conservative treatment of acute pancreatitis with huge pancreatic pseudocyst and small pancreatic tail pseudocyst about 2 years ago was admitted to our hospital for hematemesis with left upper abdominal pain on 21 September 1997. Emergency endoscopic examination was performed and active bleeding from submucosal tumor like lesion of the stomach at the upper-posterior-body near the greater curvature was detected. Color doppler ultrasonography and abdominal dynamic CT demonstrated a 3×3-cm mass in the tail of the pancreas. Splenic angiography revealed a tumor of the same size stain So we made a diagnosis of a splenic pseudoaneurysm with fenestration into the stomach. Distal pancreatectomy, splenectomy and partial gastrectomy were performed. Histological examination revealed that a false splenic aneurysm caused the hemorrhagic pancreatic pseudocyst. Fenestration into the digestive tract of a hemorrhagic pancreatic pseudocyst is very rare. Only 7 cases have been reported in Japan since 1972. Because of it's severe symptoms and high mortality, color doppler ultrasonography, dynamic CT and angiography should be used for a timely detection of the pancreatic pseudocyst.

Key words
hemorrhagic pancreatic pseudocyst, gastrointestinal bleeding, pancreatitis

Reprint requests
Kanji Ishihara Department of Surgery, Ishikiriseiki Hospital 18-28 Yayoicyou, Higashioosaka City, 579-8026 JAPAN

Accepted
November 13, 1998

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