Needle knife precut-induced bleeding from a “pancreatic cyst”

Abstract

When jaundice develops in a patient with acute pancreatitis, obstruction of the biliary passage is the most probable cause. Endoscopic retrograde cholangiography (ERC) is the procedure of choice to identify and, when possible, relieve the obstruction.1 Particularly in patients with gallstone-induced pancreatitis and obstructive jaundice, ERC is usually diagnostic and allows removal of impacted gallstones after endoscopic papillotomy. Other, less common causes of jaundice in patients with acute pancreatitis are common bile duct compression by an inflammatory pseudotumor in the head of the pancreas or the development of a pancreatic pseudocyst. In both events the endoscopic insertion of a temporary plastic stent into the compressed bile duct during ERC can restore the flow of bile and prevent cholangitis. This is a report of a patient with an acute episode of pancreatitis in whom a pseudoaneurysm of the inferior pancreatico-duodenal artery was mistaken for a pseudocyst. ERC with precut papillotomy was performed to relieve jaundice which resulted in severe bleeding from the aneurysm. The pseudoaneurysm was later correctly identified by color From the Department of Medicine B, University of Munster, Munster, Germany