Major arterial hemorrhage: a complication of pancreatic pseudocysts and chronic pancreatitis.

Twelve patients (11 men, one woman), aged 18 to 68 years, had major arterial hemorrhage as a direct complication of pancreatic pseudocysts and chronic pancreatitis. Chronic alcoholism (11 patients) and blunt abdominal trauma (one patient) were the basis for pancreatic disease. Spontaneous hemorrhage occurred in eight patients. Bleeding occurred into the gastrointestinal tract (eight patients), into the peritoneal cavity (four patients), and was intracystic (one patient). Splenic, pancreaticoduodenal, gastroduodenal, and gastroepiploic arteries were sources of hemorrhage. Operative procedures included local control of bleeding (six patients), distal pancreatectomy (three patients), and pancreaticoduodenectomy (one patient). Four patients died of hemorrhagic complications of pancreatic disease, including one not subjected to operation. Extirpation of diseased pancreatic tissue may lessen the morbidity and mortality attributed to this complication of pancreatitis.