Case reports in gastroenterology · 2026
Intermittent Upper Gastrointestinal Bleeding Associated with a Hemorrhagic Pancreatic Pseudocyst and Transient Cyst-Duodenal Fistula: A Case Report.
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Fadul Mohamed H, Yahia Yousef, Elmahadi Mohamed S, Balaraju Girisha
Аннотация
INTRODUCTION: Upper gastrointestinal bleeding (UGIB) is an uncommon complication of pancreatitis and may be challenging to diagnose when bleeding is intermittent and routine investigations are inconclusive. We report a case of intermittent UGIB associated with a hemorrhagic pancreatic pseudocyst and transient cystoduodenal fistula.
CASE PRESENTATION: A 29-year-old woman with biliary pancreatitis complicated by necrotizing pancreatitis and recurrent pancreatic collections presented with recurrent pancreatitis and intermittent UGIB. Imaging revealed a hemorrhagic pancreatic pseudocyst. During hospitalization, she experienced three discrete bleeding episodes over 10 days, including hematemesis, coffee ground emesis, and maroon-colored stools, with a hemoglobin nadir of 7.5 g/dL, requiring transfusion. Esophagogastroduodenoscopy revealed a duodenal bulb mucosal defect consistent with a cyst-duodenal fistula, which healed spontaneously. Repeated computed tomography angiography revealed no active bleeding or evidence of a pseudoaneurysm. Subsequent evaluation revealed pancreatic duct disruption with contrast leakage into a persistent pancreatic collection. Pancreatic duct stenting was performed, after which no further bleeding occurred.
CONCLUSION: This case highlights transient cyst-duodenal fistulization as an underrecognized mechanism of intermittent UGIB in complicated pancreatitis and emphasizes that negative angiography does not exclude the pancreatic source of bleeding.
CASE PRESENTATION: A 29-year-old woman with biliary pancreatitis complicated by necrotizing pancreatitis and recurrent pancreatic collections presented with recurrent pancreatitis and intermittent UGIB. Imaging revealed a hemorrhagic pancreatic pseudocyst. During hospitalization, she experienced three discrete bleeding episodes over 10 days, including hematemesis, coffee ground emesis, and maroon-colored stools, with a hemoglobin nadir of 7.5 g/dL, requiring transfusion. Esophagogastroduodenoscopy revealed a duodenal bulb mucosal defect consistent with a cyst-duodenal fistula, which healed spontaneously. Repeated computed tomography angiography revealed no active bleeding or evidence of a pseudoaneurysm. Subsequent evaluation revealed pancreatic duct disruption with contrast leakage into a persistent pancreatic collection. Pancreatic duct stenting was performed, after which no further bleeding occurred.
CONCLUSION: This case highlights transient cyst-duodenal fistulization as an underrecognized mechanism of intermittent UGIB in complicated pancreatitis and emphasizes that negative angiography does not exclude the pancreatic source of bleeding.