1988 Volume 30 Issue 6 Pages 1255-1268_1
Hemorrhage into pancreatic pseudocyst is known as a rare but the most rapidly lethal complication of chronic pancreatitis. To the best of our knowledge, there is no report in the Japanese literature that pseudoaneurysm of the splenic artery was diagnosed with pulsed Doppler sonography. A 40-year-old male with a long history of alcohol abuse was admitted to our hospital because of severe epigastric pain with radiation to back on September 22, 1986. Physical examination showed an acutely ill man with hypertension ; 220 systolic, 140 diastolic. There was tenderness in uppear abdomen. No masses were palpable. Abdomen was flat and soft. Laboratory findings on admission revealed almost within normal limits except for elevated serum trypsin and elastase level (reported later). The patient was initially treated conservatively under suspected diagnosis of hemorrhage into pancreatic pseudocyst. On September 26, he developed agonizing pain again when he went to toilet. Computed tomography was taken three times at different day. CT showed an extremely characteristic findings of hemorrhage into pancreatic pseudocyst corresponding in timing to each phase of acute bleeding. Ultrasonography revealed a sonolucent mass in the tail of the pancreas. Pulsed Doppler US disclosed a turbulent arterial signal within this mass. Celiac angiography revealed pseudoaneurysm of the splenic artery. Hemobilia was observed by fiberoptic endoscopy. On the 6th days after admission, he underwent operation. Pancreatic pseudocyst with acute hemorrhage was found. Ligation of splenic artery, splenectomy and internal drainage in a form of Roux-Y anastomosis were carried out. He was discharged without further pain or bleeding.
