A case of hemorrhagic pancreatic pseudocyst fenestrating into the transverse colon

Abstract

A 52-year-old man with a 1-year history of pancreatic pseudocyst was admitted for melena in July, 1999. Colonoscopy showed a little coagulation near the splenic flexure, but no fresh bleeding. Abdominal computed tomography (CT) showed the 4 cm cyst including the gas in the pancreas tail, The cyst showed a mosaic pattern in ultrasonography. Endoscopic retrograde cholangiopancreatography (ERCP) revealed irregularity and stenosis of the main pancreatic duct and contrast media leaked from the end of the duct. Angiography showed an aneurysm of the splenic artery. Following these findings, we diagnosised as the pancreatic pseudocyst fenestrating into the colon. Therefore, the pancreas tail, the spleen, and the transvers colon was resected. Pathological examination revealed the fistula between the pseudocyst and the colon, and a splenic artery had ruptured into the cavity of the pseudocyst, forming the pseudoaneurysm. The postoperative course was uneventful. A pancreatic cyst fenestrating into the colon is a very rare case, which has been reported in 4 cases including ours in the Japanese literature.