Major hemorrhage from pseudocysts and pseudoaneurysms caused by chronic pancreatitis: surgical therapy

Acute hemorrhage from pseudocysts and pseudoaneurysms is the most rapidly lethal complication of chronic pancreatitis. Diagnostic procedures and therapy are still a subject of controversy. We report our experience with 10 patients operated on during the past 10 years. Of these patients, 5 had acute gastrointestinal hemorrhage, 2 had intraperitoneal bleeding, and 3 presented with severe unexplained anemia. Selective visceral angiography performed in 6 patients provided a specific diagnosis in 5 cases. All patients underwent surgical therapy: transcystic arterial ligation and external pancreatic pseudocyst drainage in 5 cases, distal pancreatectomy in 3 cases, and pancreaticoduodenectomy in 2 cases. Gastrectomy was necessary for control of hemorrhage in 1 case. One patient died of sepsis after a pancreaticoduodenectomy. No rebleeding occurred. Surgical therapy with low mortality and morbidity is an acceptable procedure to control bleeding and to treat the underlying pseudocyst. Distal pancreatectomy is recommended to treat bleeding lesions situated in the tail of the pancreas and transcystic arterial ligation seems to be the appropriate procedure to treat bleeding lesions situated in the head and body of the pancreas.