S4705 Pseudoaneurysm-Related Gastrointestinal Bleed in Pancreatitis: A Case Series and Diagnostic Challenges

Introduction: Gastrointestinal (GI) bleeding in the context of pancreatitis is a rare but morbid complication that may be misattributed to other common causes. Herein, we present 3 cases that emphasize the importance of clinician awareness, early recognition, and accurate diagnosis of visceral artery pseudoaneurysm (PSA) in the setting of pancreatitis. Case Description/Methods: Case 1: A 61-year-old with history of pancreatitis (diagnosed 3 years prior) presented with hematemesis. Esophagogastroduodenoscopy (EGD) without evidence of active bleeding. Computed tomography with angiography (CTA) revealed necrotizing pancreatitis with a 10 mm PSA in the distal splenic artery. Angiography revealed multiple PSAs in the middle and lower poles of the splenic artery and interventional radiology guided coil embolization was performed. Case 2: A 64-year-old man with history of necrotizing pancreatitis presented with 3 episodes of melena. EGD with blood in the stomach and duodenum. An area of inflammation with a fistulous tract was found in the 1st part of duodenum. CTA revealed aneurysm of the gastroduodenal artery measuring 8 mm. interventional radiology performed coil embolization of GDA with cessation of overt bleeding. Case 3: A 45-year-old woman with history of pancreatitis (diagnosed 1 year prior) presented with hematemesis. esophagogastroduodenoscopy with blood in the stomach however no source identified. Patient continued with intermittent GI bleed which required 10 units of blood and underwent an exploratory laparotomy. CTA revealed a large PSA of the splenic artery, Interventional radiology performed coil embolization with cessation of overt bleeding. Discussion: These cases highlight the importance of early recognition of visceral artery PSA as a potential source of gastrointestinal bleeding in the context of necrotizing pancreatitis. Timely identification enables prompt intervention and improves patient outcomes. Notably, the interval between the diagnosis of pancreatitis and the onset of PSA-related bleeding is highly variable, with some cases occurring years after the initial diagnosis. Intraluminal GI bleeding may result from subtle fistulization between a peripancreatic collection and the GI tract, which can present intermittently and pose significant diagnostic challenges.