ACUTE ABDOMINAL-PAIN IN CHRONIC-PANCREATITIS - HEMORRHAGE FROM A PSEUDOANEURYSM

An alcoholic, 67-year old retired male nurse complained of abdominal p ain, loss of appetite and weight loss of 10 kg within one year. Based on elevated serum enzyme levels, ultrasonography and computed tomograp hy examinations, an acute attack of chronic pancreatitis with several pancreatic pseudocysts was diagnosed. Ultrasonographically, an 1.8 cm phi, echo-free, pulsatile, space-occupying lesion, suggestive of a pan creatic pseudoaneurysm, was found at the right lateral margin of an al most echo-free pseudocyst measuring 6.8 x 5.6 x 5.0 cm in the head of the pancreas. Shortly before the planned discharge when the patient fe lt well, he developed acute abdominal pain. An immediate ultrasound ex amination showed an inhomogenous and echo-dense pseudocyst, in short, an acute hemorrhage. Rupture of the pseudoaneurysm of the Arteria gast roduodenalis was suspected and later confirmed by angiography and lapa rotomy. After proximal and distal ligation of the vessel and fibrin se aling of the inner surface of the cyst, the patient recovered and, und er alcohol abstinence, has been free of symptoms since one year.