Eight patients over an 8-year period required operation for spontaneou
s hemorrhage as a complication of a pancreatic pseudocyst. Three patie
nts presented with abdominal pain or jaundice and bled in hospital whi
le undergoing work-up. Four patients were admitted with upper gastroin
testinal bleeding and one with intraperitoneal bleeding. Five patients
were managed by pancreatic resection (two of the head and three of th
e tail) and three were managed by arterial ligation and internal drain
age. There was one death (mortality rate, 12.5%). The first four patie
nts in the series had their operations delayed secondary to a perceive
d need for further work-up or an inability to make an exact diagnosis
of the bleeding site. All rebled, necessitating an emergency operation
. The last four patients underwent an expedited workup and operation.
Successful treatment of bleeding pancreatic pseudocysts requires good
surgical judgment, especially when nonoperative methods fail or aren't
applicable. The risk of recurrent hemorrhage is high, suggesting the
need for immediate intervention once the diagnosis is made. Resection
provides definitive control, although selected patients with easily ac
cessible vessels may be managed more conservatively with ligation and
drainage.