MAJOR HEMORRHAGE ASSOCIATED WITH A PSEUDOCYST IN CHRONIC-PANCREATITIS- A GASTROSURGICAL CHALLENGE

During the fifteen years between 1979 and 1994, ten patients with alco hol-associated chronic pancreatitis were treated for acute haemorrhage from pancreatic pseudocyst. Five of the cases took place in the last two years of the period. All patients were men with a median age of 39 .5 years and with a mean of six years of alcohol misuse. Seven patient s presented with massive gastrointestinal bleeding, two with intraperi toneal and one with retroperitoneal bleeding. In six patients the pseu docyst had perforated into the stomach or duodenum. Pancreatic resecti on resulted in permanent haemostasis in those patients it was attempte d to perform, whereas ligation of the bleeding site failed in three ou t of four patients. One angiographic embolisation resulted in a good p rimary result but after 77 days the patient was operated on for recurr ent bleeding. There was no hospital mortality, but altogether five pat ients were reoperated on for recurrent haemorrhage and six patients ha d other postoperative complications. Haemorrhage from pancreatic pseud ocyst must be suspected in patients with anamnestic alcohol misuse and major gastrointestinal bleeding. Aggressive diagnostic evaluation, ex perience in pancreatic surgery, and operative strategies consisting of either resection or extracystic ligation are mandatory in the treatme nt of this acute condition.