Late bleeding after EUS-guided transjejunal drainage of a pancreatic pseudocyst in a Roux-en-Y patient.

Endoscopic ultrasonography (EUS)-guided transgastric and transduodenal drainage of a pancreatic pseudocyst (PP) has become a standard and safe procedure for nonsurgical treatment. However, there are only four reports on transjejunal drainage of PP in a patient with or without altered anatomy. Herein, we report a case of EUS-guided transjejunal PP drainage in a patient with previous Roux-en-Y reconstruction. A 58-year-old man, who had previously undergone total gastrectomy with Roux-en-Y, was admitted to another hospital because of fever, abdominal pain, nausea and vomiting. Computed tomography showed a 22 cm PP. Then, EUS-guided transjejunal PP drainage was carried out. Twenty-three days after the procedure and 3 days after the patient started eating, the hematemesis was seen. Emergency endoscopy showed bleeding around a transjejunal fistula. A 6-Fr nasocystic catheter was placed into the cyst again for lavage and hemostasis as tamponade. After 1 more month, a computed tomography scan showed complete resolution of the PP with the stent still in place.