HISTORY AND ADMISSION FINDINGS: A 69-year-old woman complained of recurrent cramp-like symptoms in the upper abdomen. She admitted excessive alcohol intake. Physical examination revealed swelling and inflammation of both ankles. All other findings were unremarkable. INVESTIGATIONS: Sonography and computed tomography scan showed a cystic structure (5 cm) in the head of the pancreas. Biochemical testing revealed an anemia (Hb 7,5 mg/dl) and an elevated serum lipase (4494 U/l). Intestinal hemorrhage could not be confirmed by endoscopy. An involvement of parapancreatic structures with the pseudocyst could not be demonstrated by combination of endoscopic retrograde cholangiopancreatography (ERCP) and computed tomography (CT). COURSE: The patient died unexpectedly. Autopsy showed a rupture of the pancreatic pseudocyst into the portal vein leading to portal vein thrombosis. The cause of death was an embolism of the pulmonary arteries. Postmortal reevaluation of CT and ERCP clarified diagnostic features. CONCLUSION: Erosion of peripancreatic vessels is one of the life threatening complications in chronic pancreatitis. The complication is uncommon but should be included into differential diagnosis of recurrent intestinal bleeding.
HISTORY AND ADMISSION FINDINGS: A 69-year-old woman complained of recurrent cramp-like symptoms in the upper abdomen. She admitted excessive alcohol intake. Physical examination revealed swelling and inflammation of both ankles. All other findings were unremarkable. INVESTIGATIONS: Sonography and computed tomography scan showed a cystic structure (5 cm) in the head of the pancreas. Biochemical testing revealed an anemia (Hb 7,5 mg/dl) and an elevated serum lipase (4494 U/l). Intestinal hemorrhage could not be confirmed by endoscopy. An involvement of parapancreatic structures with the pseudocyst could not be demonstrated by combination of endoscopic retrograde cholangiopancreatography (ERCP) and computed tomography (CT). COURSE: The patient died unexpectedly. Autopsy showed a rupture of the pancreatic pseudocyst into the portal vein leading to portal vein thrombosis. The cause of death was an embolism of the pulmonary arteries. Postmortal reevaluation of CT and ERCP clarified diagnostic features. CONCLUSION: Erosion of peripancreatic vessels is one of the life threatening complications in chronic pancreatitis. The complication is uncommon but should be included into differential diagnosis of recurrent intestinal bleeding.