Pancreatogastric fistula in chronic pancreatitis: a rare and life-threatening cause of recurrent massive upper gastrointestinal bleeding

Pancreatogastric fistulas are rare but serious complications of chronic pancreatitis that can lead to life-threatening gastrointestinal bleeding due to erosion of nearby blood vessels. We present a case of a 43-year-old man with chronic calcific pancreatitis and a history of alcohol misuse, who experienced recurrent hematemesis and melena over 2 months. Despite multiple endoscopies and transfusions, the bleeding source remained unidentified until imaging revealed a fistulous tract between the pancreas and the posterior gastric wall. After failed endoscopic control, surgery confirmed the fistula and bleeding vessel, which were managed with vessel ligation and gastric resection. This case underscores the need to consider pancreatogastric fistulas in patients with chronic pancreatitis and unexplained gastrointestinal bleeding, particularly when standard investigations are inconclusive and conservative measures fail.