A 61-year-old female patient presented to emergency with gradually increasing lower gastrointestinal bleeding. Her symptoms had started two months before hospitalization with back pain. She had a palpable mass on the left upper abdomen. In digital subtraction angiography, a fusiform aneurysmatic dilatation was seen on the distal splenic artery coiling, and glue injection was performed. On laparotomy, it was seen that the cystic mass was connected to the colonic mucosa with an opening 2 cm in width. Resection of the colon segment and necrotic cyst wall, end-to-end colonic anastomosis and debridement were undertaken. Postoperative follow-up was uneventful until the 17 th day, when pancreatic drainage from the previous drain site was observed. As the amount of drainage from the fistula did not decrease, a second endoscopic retrograde cholangiopancreatography with naso-pancreatic stent placement was performed. The fistula closed 47 days after the surgery. Examination of the pathology specimen revealed non-neoplastic cystic wall with necrosis, fibrosis and fistula tract between the colon and the cyst. It should be kept in mind that acute pancreatitis affects neighboring organs and vascular structures, causing low gastrointestinal system bleeding.
Keywords: Pancreatitis, pancreatic pseudocyst, gastrointestinal hemorrhage 61 yafl›nda kad›n olgu alt gastrointestinal sistem kanamas› nedeniyle acil servise baflvurdu. fiikayetleri iki ay önce s›rtta a¤r› fleklinde bafllam›flt›. Sol üst kadranda ele gelen kitle tespit edildi. Anjiografide splenik arter distalinde anevrizma olgu¤u görüldü ve embolizasyon uyguland›. Laparotomi yap›ld›-¤›nda transvers kolona 2 cm çap›nda a¤›zlaflm›fl kistik lezyonla karfl›lafl›ld›. Kolon segmenti rezeke edilerek uç-uca anastomoz yap›ld›. Postoperatif 17. gün dren bölgesinden pankreatik s›v› gelmeye bafllad›. Drenaj miktar›n›n azalmamas› üzerine, endoskopik retrograd kolanjiopankreatografi yap›larak nazo-pankreatik kateter yerlefltirildi. Postoperatif 47. gün fistül bölgesinden ak›nt› kesildi. Patolojide nekroz içeren non-neoplastik kist, kolon ve kist ara-s›nda fibrozis bulgular› vard›. Akut pankreatit sonras› gastrointestinal sistem kanamas› olan olgularda, pankreas, vasküler yap›lar ve komflu organlar ara-s›nda fistül ak›lda bulundurulmal›d›r. Anahtar kelimeler: Pankreatit, pankreatik psödokist, gastrointestinal kanama M Ma as ss si iv ve e g ga as st tr ro oi in nt te es st ti in na al l b bl le ee ed di in ng g a af ft te er r a ac cu ut te e p pa an nc cr re ea at ti it ti is s: : R Re ep po or rt t o of f a a c ca as se e Akut pankreatiti takiben abondan gastrointestinal sistem kanamas›: Olgu sunumu