R. Mahlke et al., ACUTE ABDOMINAL-PAIN IN CHRONIC-PANCREATITIS - HEMORRHAGE FROM A PSEUDOANEURYSM, Zeitschrift fur Gastroenterologie, 33(7), 1995, pp. 404-407
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.