[page 20] [Gastroenterology Insights 2012; 4:e6]

We report a case of a 48-year-old female, who presented with refractory haemetemesis. Her oesophago-gastroduodenoscopy showed only a healing ulcer but profuse bleeding was seen from duodenum. In spite of a negative oesophago-gastroduodenoscopy she was bleed-ing profusely with haemodynamic decompen-sation. Doppler coeliac trunk showed a supra-pancreatic cystic lesion with yin-yang pattern of blood flow confirming a pseudo aneurysm involving the superior and inferior pancreatio-duodenal arterial arcade using digital subtrac-tion angiography. The conversion of a pancre-atic pseudo cyst into a pseudo aneurysm is a potential lethal complication because, when rupture occurs, mortality rises up to 40%. She was diagnosed to have pancreatic pseudocyst, psedoaneurysm and haemosuccus pancreati-cus with wirsungorrhagia and was offered arterial embolization following which she improved. Patients with chronic calcificpan-cratitis (CCP) could remain silent and can present with normal amylase and lipase. Complications such as pseudocysts or pseudoaneurysms can be asymptomatic. The pancreas should be considered a possible site of hemorrhage in CCP in cases of refractory upper gasrtrointestinal haemorrhage. We highlight the importance of looking for causes other than bleeding duodenal/gastic ulcer/ oesophageal varices in case of a refractory hametemeis giving the patient option of a non-surgical modality of treatment and it’s reduced risks.The effectiveness of embolistion for bleeding psuedoaneurysms is emphasized