DÄ internationalArchive11/2019Hematochezia Owing to a Pancreatic Pseudocyst

Clinical Snapshot

Hematochezia Owing to a Pancreatic Pseudocyst

Dtsch Arztebl Int 2019; 116: 194. DOI: 10.3238/arztebl.2019.0194a

Gachabayov, M

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Computed tomography of the abdomen with intravenous administration of contrast medium; sagittal section; arterial phase. The yellow arrow indicates the fistula connecting the pseudocyst with the colon.
Computed tomography of the abdomen with intravenous administration of contrast medium; sagittal section; arterial phase. The yellow arrow indicates the fistula connecting the pseudocyst with the colon.
Figure
Computed tomography of the abdomen with intravenous administration of contrast medium; sagittal section; arterial phase. The yellow arrow indicates the fistula connecting the pseudocyst with the colon.

A 38-year-old woman with recurring acute alcohol-related pancreatitis was admitted to the hospital with a 2-day history of hematochezia. The findings on admission
were as follows: skin pale and subicteric, heart rate 112 bpm, blood pressure 80/50 mm Hg, Hb 5.3 mg/dL, serum amylase 120 U/L, total bilirubin: 3.0 mg/dL,
direct bilirubin: 0.2 mg/dL.

Abdominal examination revealed a large palpable mass in the left upper quadrant. Ultrasonography showed this to be a cyst. Colonoscopy identified the transverse colon as the site of bleeding, but the cause remained unclear. Computed tomography with intravenous administration of contrast medium depicted a pancreatic pseudocyst with a fistula to the transverse colon (Figure). There was no persistent bleeding. Laparotomy showed a fibrous-walled pseudocyst in the omental bursa filled with hemolyzed blood and necrotic deposits. The fibrous, partly necrotic wall of the pseudocyst was the bleeding source. The pseudocyst was surgically removed and the transverse colon repaired. The postoperative course was uneventful.

Mahir Gachabayov, MD, PhD; Department of Abdominal Surgery, Vladimir City Clinical Hospital of Emergency Medicine, Vladimir, Russia, gachabayovmahir@gmail.com

Conflict of interest statement: The author declares that no conflict of interest exists.

Translated from the original German by David Roseveare.

Cite this as: Gachabayov M: Hematochezia owing to a pancreatic pseudocyst.
Dtsch Arztebl Int 2019; 116: 194. DOI: 10.3238/arztebl.2019.0194a

Computed tomography of the abdomen with intravenous administration of contrast medium; sagittal section; arterial phase. The yellow arrow indicates the fistula connecting the pseudocyst with the colon.
Computed tomography of the abdomen with intravenous administration of contrast medium; sagittal section; arterial phase. The yellow arrow indicates the fistula connecting the pseudocyst with the colon.
Figure
Computed tomography of the abdomen with intravenous administration of contrast medium; sagittal section; arterial phase. The yellow arrow indicates the fistula connecting the pseudocyst with the colon.