Reduced mortality from bleeding pseudocysts and pseudoaneurysms caused by pancreatitis

Exigent hemorrhage from pseudocysts and pseudoaneurysms is the most rapidly lethal complication of pancreatitis. Of eight patients with this unusual entity seen by us, all had acute gastrointestinal hemorrhage; two patients had intraperitoneal bleeding as well. Preoperative visceral arteriograms accurately defined the bleeding lesion and greatly aided in planning operative strategy in six patients. Emergency celiotomy and arterial ligation were accomplished in seven patient, and one patient underwent successful transcatheter arterial embolization. Pancreatic resection was not required in any patient for control of hemorrhage, although gastrectomy was necessary in three cases. One elderly patient died of sepsis five weeks after operation. Our mortality of 12.5% compares favorably with the 37% overall mortality from 123 cases reported in the literature.