Bleeding caused by gastroduodenal artery pseudoaneurysm in a patient with an infected pancreatic pseudocyst

We report a 52 year old man with a pancreatic pseudocyst, that was admitted with severe abdominal pain, severe vomiting, fever and malaise. The clinic al picture as considered secondary to a pseudocyst infection and the patien t was operated, draining the infected cyst performing a necrosectomy and pa ncreatocystojejunostomy. Forty eight hours after the operation, an ostomy b leeding was detected. A upper mesenteric artery angiography showed two pseu doaneurysms in the gastroduodenal artery, that were embolized. Bleeding sto pped initially, but seven days later, it reappeard. The patient was subject ed to an emergency pancreatoduodenectomy. Postoperative evolution was uneve ntful and the patient was discharged two weeks later. Spontaneous bleeding of pseudoaneuroysms secondary to chronic pancreatitis is a complication wit h a 15 to 40% mortality that must be bore in mind (Rev Med Chile 2001; 129: 81-85).