We report the case of a man who developed life-threatening massive gastric
hemorrhage 3 months after undergoing cystogastrostomy for a
pancreatic pseudocyst. After cystogastrostomy, the
pancreatic pseudocyst became remarkably reduced in size, having the appearance of a shallow
ulcer by
barium study. However, tarry stools and
hematemesis developed 3 months later, 6 days after which sudden massive
hematemesis and
melena occurred with severe
hypotension. At emergency operation, a large artery at the bottom of the reduced
cyst wall was found to have ruptured and hemostasis was achieved by
suture ligation. The splenic artery was suspected as the
bleeding point because a 95% abrupt
stenosis was seen on angiography-performed the next day. Thus, the risk of
hemorrhage occurring after internal drainage of a
pancreatic pseudocyst even in the late postoperative period should always be borne in mind.