Severe hemorrhage associated with pancreatic pseudocysts: report of two cases.

Severe hemorrhage from pancreatic pseudocysts is a rare condition that poses a diagnostic and therapeutic challenge. Two cases of preoperative intracystic bleeding and massive postoperative gastrointestinal hemorrhage observed during the last year form the basis of the present report. In the first patient, transcystic suture ligation of the bleeding vessel was necessary to control this life-threatening and dramatic condition--External drainage of the cyst was followed by an uneventful postoperative course. In the second patient, massive gastrointestinal bleeding occurred after cysto-gastrostomy, and neither endoscopy nor arteriography was able to identify the source. Despite aggressive medical and surgical therapy, the patient died. Massive intracystic or gastrointestinal hemorrhage caused by rupture of pseudoaneurysms into pancreatic pseudocysts still remains a rare but severe condition, difficult to treat and affected by high mortality rates. Angiography should be performed routinely in the preoperative assessment of pancreatic pseudocysts, even when the other diagnostic techniques do not raise the suspicion of pseudoaneurysm formation. After internal drainage procedures early surgery is recommended whenever GI bleeding occurs in the postoperative course.