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Infected Pancreatic Pseudocyst Ruptured into Stomach and Colon Associated with Splenic Artery Pseudoaneurysm

Hiroshi Ohkawara, Akiko Shichishima-Nakamura, Kazuhiko Ikeda, Masumi Sukegawa, Miki Furukawa, Takahiro Sano, Koki Ueda, Satoshi Kimura, Akiomi Yoshihisa, Hideyoshi Noji, Kazuei Ogawa,Yasuchika Takeishi

Context Pancreatic pseudocysts, which are known to be a common complication of chronic pancreatitis, occasionally result in spontaneous intestinal perforation. However, multiple perforations of pancreatic pseudocysts into internal organs are rarely seen. Case report A 46-yearold man was admitted to our hospital complaining of left upper abdominal pain, where a palpable mass was found. Abdominal computed tomography scan showed a large pancreatic pseudocyst in the tail of the pancreas and a splenic artery pseudoaneurysm. The pseudoaneurysm was treated by urgent percutaneous transarterial embolization. Endoscopic examinations revealed fistulas that had ruptured into the stomach and transverse colon. The patient had a high fever with prolonged elevated C-reactive protein. Contaminated fluid/debris was eliminated from the infected pseudocyst cavity under colonoscopy and ileostomy, followed by spontaneous closure of the fistulas. Conclusion This is a rare patient of a ruptured pancreatic pseudocyst in the stomach and colon, complicated by a splenic artery pseudoaneurysm.