PANCREATIC PSEUDOCYST AS A CAUSE OF UPPER GASTROINTESTINAL-BLEEDING

A 67-year-old man with a history of an attack of pancreatitis was repe atedly investigated for recurrent gastrointestinal bleeding necessitat ing blood transfusions. Routine investigations did not reveal the sour ce of bleeding, Repeated angiograms also were not diagnostic. A hot sp ot identified on a Tc-99m-pertechnate-labelled erythrocyte scan prompt ed an endoscopic retrograde cholangio-pancreatography (ERCP), which sh owed bleeding through the papilla of Vater. The source of bleeding app eared to be a small pancreatic pseudocyst. The patient was treated wit h a duodenopancreatectomy in which the pylorus was preserved. No reble eding occurred since the operation. Pancreatic pseudocysts must be con sidered as a source of upper gastrointestinal bleeding in patients wit h bleeding of ''obscure'' origin. Tc-99m-pertechnate-labelled erythroc yte scanning and ERCP may be helpful, even when angiography is normal.