BLEEDING PSEUDOCYSTS RESULTING FROM PSEUD OANEURYSM IN CHRONIC-PANCREATITIS - DIAGNOSIS AND MANAGEMENT

Bleeding pseudocysts respectively pseudoaneurysms represents a seldom complication of chronic pancreatitis in owing to arrosion of pancreati c or peripancreatic arteries. The potential rupture into neighbouring organs or in the peritoneal cavity is accompanied with paramount livet hreatening risks. During the last years we observed 3 patients with ac ute intestinal bleeding caused by pseudocysts converted to pseudoaneur ysms. The goal of our report is to analyze the diagnostic tools and th e management of patients with bleeding pancreatic pseudocysts, also we ll establish the clinical constellation, which is typical for this com plication, the best diagnostic tool and the modalities to immediate co ntrol of the acute bleeding situation. All three patients suffered fro m chronic pancreatitis and alcohol abuse. The first patient had a know n pancreatic pseudocyst, which penetrated through the gastric wall and caused a livethreatening bleeding. The seond patient was admitted in owing to melena. The examinations yielded a pancreatic pseudocyst with hematosuccus pancreatis. The third patient suffered from abdominal pa in and vertigo caused by anemia. With endoscopy, Cat and celiacography a pancreatic pseudocyst with cysto-colic fistula has been identified. The color-doppler ultrasound revealed a pseudoaneurysm supplied from a splenic artery branch. With management of these patients with hemorr hagic complications of pancreatic pseudocysts we acquired the followin g findings: 1. Patients with known chronic pancreatitis and abdominal tumor, especially when accompanied by epigastric pain and anemia, are highly suspicious for pancreatic pseudoaneurysms. 2. The color-doppler ultrasound is the best diagnostic tool, since this investigation can establish the pseudoaneurysm and identify the source. 3. During the op eration we recommend to control first the subdiaphragmatic aorta, sinc e the local hemostasis can become very difficult in owing to peripancr eatic inflammatory alterations.