Kenji Fujimori

Pancreatic pseudocyst involving the spleen

Summarypancreatic pseudocyst involving the spleen in a 52-year-old man is reported, with review of the literature. Physical examination and laboratory data revealed no specific abnormalities. A CT scan demonstrated multiple calcifications throughout the pancreas, with a cystic mass in the tail of the pancreas involving the spleen. Endoscopic retrograde cholangiopancreatography (ERCP) revealed a dilated main pancreatic duct with a direct communication to the cyst. Distal pancreatectomy with splenectomy was performed on a diagnosis of pancreatic pseudocyst. The 10x9.5x7cm in size cyst had no epithelial lining on its wall. The amylase level in the cystic fluid was 23424 IU/l. The literature reveals that hemorrhagic complications are common and often serious. Timely surgical intervention is advocated to reduce mortality and morbidity from complications.

Massive gastric bleeding from pancreatic pseudocyst, caused by rupture of pseudoaneurysm

Massive bleeding into a pancreatic pseudocyst is an unusual but life-threatening clinical condition. In this report, we present a case of massive gastric hemorrhage from a pancreatic pseudocyst, caused by rupture of a pseudoaneurysm of the splenic artery. The patient was successfully managed by total gastrectomy with splenectomy and distal pancreatectomy. Of a total of 66 cases in our Japanese literature review, only 5 cases of gastric hemorrhage associated with pancreatic pseudocyst have been reported, including the case herein presented. Diagnosis and therapeutic strategy are discussed.