Abstract
A case of hemorrhage from a ruptured pancreatic pseudocyst that was caused by the performance of endoscopic ultrasonography (EUS) and which was treated by an emergency operation is presented in this report. A 43-year-old man with a long history of alcohol abuse was referred to us because of a cyst in the pancreatic tail. The patient had initially been treated conservatively under the presumed diagnosis of a pancreatic pseudocyst associated with alcoholic chronic pancreatitis. However, he was admitted to our hospital because of enlargement of the pancreatic cyst. We performed EUS to observe the cyst before drainage. During the EUS procedure, the patient complained of abrupt onset of abdominal pain and lapsed into shock. Enhanced CT showed rapid enlargement of the cyst and fluid collection in the peritoneal cavity. Emergency laparotomy was performed under the suspicion of intraperitoneal hemorrhage from the ruptured pancreatic pseudocyst. The intraoperative findings confirmed that the pancreatic pseudocyst had ruptured, resulting in the occurrence of massive ascites with hemorrhage. Distal pancreatectomy and splenectomy were performed. Intraabdominal bleeding caused by rupture of a pancreatic pseudocyst is a relatively rare complication. It is possible that the intraperitoneal hemorrhage from the ruptured pancreatic pseudocyst was caused during the EUS procedure performed in this case.
