A Surgically Treated Case of Pancreatic Pseudocyst Hemorrhage in Which a Bleeding Etiology Was Not Identified by Angiography

Abstract

A 68-year-old man had no past medical history; however, he was a heavy drinker. He had visited a previous hospital for stomach ache and was diagnosed with chronic pancreatitis and pancreatic pseudocyst hemorrhage. He underwent conservative treatment. Since the same symptoms recurred twice after discharge, he was referred to our hospital. CT showed a cystic lesion at the pancreatic head, which was strongly enhanced during the late phase, and no aneurysm. Angiography also failed to identify a bleeding etiology. Despite conservative treatment, abdominal pain and anemia progression continued. Therefore, we decided to perform pancreaticoduodenectomy. Intraoperative and macroscopic findings showed no intracystic hemorrhage, and a bleeding etiology could not be identified; however, microscopic findings suggested chronic bleeding from the cystic wall. There is no clear consensus on treatment of pancreatic pseudocyst hemorrhage with an angiographically unidentified bleeding etiology. Based on the present case and a review of the literature, we suggest that conservative treatment is not clearly effective for pancreatic pseudocyst hemorrhage, and that surgical treatment, including combined resection of other organs, should be selected.