Bleding From the Splenic Artery into a Pancreatic Pseudocyst with a Coexisting Microfistula to the Transverse Colon as Atypical Recurent Masive Gastrointestinal Bleding
Here we present a case of a 49-year old male patient who was hospitalized at our Clinic from 2 to 16 December 2008 due to recurrent massive gastrointestinal bleeding. It was a patient with a history of recurrent pancreatitis. He had a history of surgical treatment for postinflamamtory pancreatic cyst (Jurasz cystogastrostomy). From 28.01.2007 to 16.12.2008 he was hospitalized five times. During the last hospitalization he received a total of 12 units of packed red blood cells. Neither gastroscopy nor colonoscopy did demonstrate the site of bleeding. AngioCT of the abdominal cavity demonstrated clearly enlarged spleen and a well delineated region, 30×35 mm, reaching spleen hilum, filled with dense fluid suggesting a vascular fistula, in the projection of the body and tail of the pancreas. The patient was qualified for laparotomy. Intraoperatively, bleeding from the splenic artery into the pancreatic pseudocyst with coexisting microperforation to the transverse colon was detected. The pancreatic cyst was opened and drained, the bleeding blood vessel as well as the splenic artery were underpinned. Splenectomy was performed and wall of the transverse colon was repaired. The patient underwent reoperation due to adhesion related small bowel obstruction on day 30 after the procedure. Currently the patient is in good general condition, without complaints, undergoes periodic follow up in the outpatient setting.