2021 Volume 63 Issue 11 Pages 2350-2355
A pancreatic pseudocystocolonic fistula is rare. We report a case of a 53-year-old man who was transferred to the emergency department after a syncopal episode. He observed intermittent hematochezia one week prior to presentation and was diagnosed with internal hemorrhoids. Rectal examination, blood investigation results, and esophagogastroduodenoscopy did not reveal any significant abnormalities. After admission, we observed hematochezia accompanied by clots. Colonoscopy performed on day 2 of hospitalization revealed a large submucosal tumor-like eminence accompanied by a reddish membrane in the transverse colon (T/C). Computed tomography revealed a pancreatic pseudocyst concomitant with a large splenic aneurysm that compressed the T/C. Embolization was scheduled on day 3 of hospitalization; however, the patient developed acute abdominal pain and massive hematochezia accompanied by clots at midnight on day 2 and was transferred to another hospital to undergo an emergency operation. Histopathological evaluation showed the T/C penetration by a pancreatic pseudocyst concomitant with a splenic aneurysm. Major complications of pancreatic pseudocysts include infection, gastric outlet or biliary obstruction, bleeding, and perforation of adjacent organs. Based on findings reported in previous studies, a pancreatic pseudocystocolonic fistula refers to fistula formation at the splenic flexure. However, a submucosal tumor-like eminence without pulsations is observed in patients in whom the penetration of adjacent organs does not lead to fistula formation. Therefore, clinicians should consider a pancreatic pseudocystocolonic fistula in the differential diagnosis in patients who show a relatively large submucosal tumor-like eminence without pulsations at the splenic flexure.
