Korean J Pancreas Biliary Tract.  2014 Apr;19(2):111-115.

Recurrent Upper Gastrointestinal Bleeding from Gastro-Cystic Fistula and Pancreatic Pseudocyst Bleeding

  • 1Department of Internal Medicine, Incheon Sarang Hospital, Incheon, Korea.
  • 2Division of Gastroenterology and Hepatology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea. drkim@gilhospital.com


Bleeding from pancreatic pseudocyst is a rare complication. Furthermore, massive upper gastrointestinal (GI) bleeding from gastro-cystic fistula formation and intracystic bleeding are both extremely rare and are also potentially fatal. A 53-year-old male was referred to the emergency room with melena and hematemesis. An urgent endoscopy revealed a massive gastric hematoma but showed no specific bleeding focus. Gastrocystic fistula formation and intracystic bleeding leakage to the stomach were suspicious in the follow-up endoscopy. A contrast-enhanced computed tomography scan demonstrated splenic artery pseudoaneurysm and extravasation of contrast media into the cyst that was abutted to the greater curvature side of the stomach. A splenic artery embolization was performed and no further bleeding occurred after embolization. Upper GI bleeding from gastro-cystic fistula and intracystic bleeding are rare but possible. Therefore, this possibility should be considered in the unknown cause of an upper GI bleeding in a patient with pancreatic pseudocyst.


Upper gastrointestinal bleeding; Fistula; Splenic artery pseudoaneurysm; Pancreatic pseudocyst
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