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Laparoscopic Duodenum-Preserving Pancreatic Head Resection via Inferior Infracolic Approach: A Surgical Approach for Benign Lesions
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[Massive hemorrhage from a pancreatic pseudocyst into the duodenum]

T Krejcí1, J Hoch, J Leffler

  • 1Chirurgická klinika 2. LF UK a FN Motol, Praha. k.tom@atlas.cz

Rozhledy V Chirurgii : Mesicnik Ceskoslovenske Chirurgicke Spolecnosti
|November 19, 2003
PubMed

Insights

Bleeding from pancreatic pseudocysts due to chronic pancreatitis can be fatal. This case report details a massive bleed from the gastroduodenal artery, requiring urgent surgery and highlighting diagnostic and therapeutic challenges.

Area of Science:

  • Gastroenterology
  • Vascular Surgery
  • Radiology

Background:

  • Chronic pancreatitis frequently leads to pancreatic pseudocysts and pseudoaneurysms.
  • Hemorrhage from these lesions carries a high mortality rate, especially with conservative management.
  • Current diagnostics include angiography and contrast-enhanced CT, with therapy often involving percutaneous transvascular embolization (PTE) or surgery.

Observation:

  • A 44-year-old patient with chronic pancreatitis presented with massive bleeding from a pancreatic pseudocyst eroding the gastroduodenal artery.
  • Spontaneous pseudocyst perforation into the duodenum resulted in hemorrhagic shock, necessitating emergency surgical intervention.
  • The bleeding vessel was identified via longitudinal gastroduodenotomy and pseudocyst dissection through the duodenal wall.

Findings:

  • Successful identification and management of a bleeding gastroduodenal artery pseudoaneurysm within a pancreatic pseudocyst.
  • Demonstration of a rare complication of chronic pancreatitis: spontaneous pseudocyst perforation causing massive gastrointestinal hemorrhage.
  • Surgical approach via gastroduodenotomy allowed direct visualization and control of the bleeding source.

Implications:

  • Highlights the critical need for prompt diagnosis and aggressive management of bleeding pancreatic pseudocysts.
  • Underscores the limitations of conservative treatment and the potential role of surgical intervention in life-threatening hemorrhage.
  • Emphasizes the importance of considering surgical options in complex cases refractory to endovascular techniques.

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