Acute abdominal pain in chronic pancreatitis: hemorrhage from a pseudoaneurysm?

An alcoholic, 67-year old retired male nurse complained of abdominal pain, loss of appetite and weight loss of 10 kg within one year. Based on elevated serum enzyme levels, ultrasonography and computed tomography examinations, an acute attack of chronic pancreatitis with several pancreatic pseudocysts was diagnosed. Ultrasonographically, an 1.8 cm phi, echo-free, pulsatile, space-occupying lesion, suggestive of a pancreatic pseudoaneurysm, was found at the right lateral margin of an almost echo-free pseudocyst measuring 6.8 x 5.6 x 5.0 cm in the head of the pancreas. Shortly before the planned discharge when the patient felt well, he developed acute abdominal pain. An immediate ultrasound examination showed an inhomogenous and echo-dense pseudocyst, in short, an acute hemorrhage. Rupture of the pseudoaneurysm of the Arteria gastroduodenalis was suspected and later confirmed by angiography and laparotomy. After proximal an distal ligation of the vessel and fibrin sealing of the inner surface of the cyst, the patient recovered and, under alcohol abstinence, has been free of symptoms since one year.

[Gas in the pancreas: value of computed tomography]. / Gas im Pankreas: Bedeutung der Computertomographie.

Intrapancreatic gas in acute pancreatitis is generally due to infection with gas-forming organisms. CT provides evidence of pancreatitis, its extent and complications. The demonstration of gas in an inflamed pancreas indicates abscess formation and is an indication for surgical intervention. A review of our own patients has shown abscess formation in six out of seven patients with gas in the pancreas. The differential diagnosis of gas collections in the region of the pancreas is discussed and illustrated by examples.