title: Pancreatic pseudocyst bleeding associated with massive intraperitoneal hemorrhage.
abstract: BACKGROUND
  Pancreatic pseudocyst bleeding is an unusual entity of acute abdomen, usually occurring among alcoholics. A high mortality developed in patients with conservative treatment of hemorrhagic pancreatic pseudocyst. We report a 37-year-old male with a pseudoaneurysm in the tail of the pancreas presenting with sudden onset of abdominal pain and swelling. Emergency laparotomy after blood transfusion and fluid resuscitation was successfully performed.
  
  
  METHODS
  An abdominal radiography showed multiple calcifications in the epigastric area. Computed tomography of the abdomen showed a cystic lesion with a calcified wall in the tail of the pancreas and a large amount of ascites. After contrast enhancement, there was hemorrhage into the pancreatic pseudocyst with extravasation of contrast into the peritoneal cavity.
  
  
  RESULTS
  At operation, active bleeding was noted from a ruptured pseudocyst in the tail of the pancreas and ligation of the bleeding vessel was done.
  
  
  CONCLUSIONS
  Hemorrhage into the pancreatic pseudocyst associated with intraperitoneal bleeding is a potentially life threatening condition. Emergency surgical treatment should be carried out as soon as possible.
authors.affiliation: Department of Medicine, Division of Gastroenterology, Kuo General Hospital, No 22. Sec 2, Ming-Sheng Road, Tainan 703, Taiwan. shchiu@kgh.com.tw
authors.forename: Hsin-Hui
authors.initials: HH
authors.lastname: Chiu
authors.forename: Chan-Ming
authors.initials: CM
authors.lastname: Chen
authors.forename: Ko-Chin
authors.initials: KC
authors.lastname: Wang
authors.forename: Yen-Yuan
authors.initials: YY
authors.lastname: Lu
authors.forename: Lein-Ray
authors.initials: LR
authors.lastname: Mo
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D006465:Hemoperitoneum / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006488:Hemostasis, Surgical / Q000379:methods; D006801:Humans; D008026:Ligation; D008297:Male; D010192:Pancreatic Pseudocyst / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D011860:Radiography, Abdominal; D012422:Rupture, Spontaneous; D014057:Tomography, X-Ray Computed