title: Late bleeding after EUS-guided transjejunal drainage of a pancreatic pseudocyst in a Roux-en-Y patient.
abstract: 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.
authors.affiliation: Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan. itoi@tokyo-med.ac.jp
authors.forename: Takao
authors.initials: T
authors.lastname: Itoi
authors.forename: Fumihide
authors.initials: F
authors.lastname: Itokawa
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sofuni
authors.forename: Junko
authors.initials: J
authors.lastname: Umeda
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Tsuchiya
mesh_terms: D000713:Anastomosis, Roux-en-Y; D004322:Drainage / Q000009:adverse effects* / Q000379:methods; D016099:Endoscopy, Gastrointestinal; D019160:Endosonography / Q000009:adverse effects*; D005743:Gastrectomy / Q000379:methods*; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D016558:Hemostasis, Endoscopic; D006801:Humans; D008297:Male; D008875:Middle Aged; D010192:Pancreatic Pseudocyst / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D013274:Stomach Neoplasms / Q000150:complications / Q000601:surgery*; D013997:Time Factors