A Case Report of Hemorrhagic Pancreatic Pseudocyst Complicated with Hemosuccus Pancreaticus and Fenestration into the Stomach

Kyoei Morozumi, Hiroshi Miyazaki, Akio Furukawa, Makoto Nakamaru, Eisuke Itoh, Toshibumi Kawashima and Hidaka Kohno

Department of Surgery, Fussa Hospital

A 47-year-old man who drank alcohol heavily and had a medical history of acute pancreatitis was admitted to our hospital due to upper left abdominal pain and hematemesis. Endoscopic examination showed active bleeding from a stomach ulcer at the middle-posterior-body, and hemoclipping was conducted. Abdominal computed tomography showed blood was retained in the stomach and a pancreatic pseudocyst. Splenic angiography showed active bleeding from the branch of the splenic artery into the pancreatic pseudocyst and subsequently to the major pancreatic duct and to the duodenum. The splenic artery was occluded with a balloon catheter. This man was eventually diagnosed with having hemorrhage of the pancreatic pseudocyst complicated by hemosuccus pancreaticus and fenestration into the stomach, and underwent distal pancreatectomy, splenectomy, and partial gastrectomy. Many cases of acute alcholic pancreatitis are followed by chronic pancreatitis, and morphologic abnormalities are often obserbed, and a pseudocyst of alcholic pancreatitis has high risk of bleeding. If it were fenestrated into neighboring internal organs, sometimes it caused gastrointestinal bleeding. The vascular occlusion is an useful therapy for hemorrhage of the pancreatic pseudocyst, but operation is needed often thereafter. Stomach ulcer complicated with chronic pancreatitis must be diagnosed from pancreatic pseudocyst fenestrated into the stomach.

Key words
hemosuccus pancreaticus, hemorrhagic pancreatic pseudocyst, gastrointestinal bleeding

Reprint requests
Kyoei Morozumi Department of Surgery, Fussa Hospital 1-6-1 Kamidaira, Fussa, Tokyo, 197-8511 JAPAN

Accepted
July 30, 2001

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