Overt gastrointestinal bleeding from a pseudoaneurysm and fistulous tract formation complicating a case of necrotizing pancreatitis

Abstract

Pancreatic pseudoaneurysm is a rare but potentially fatal complication of necrotizing pancreatitis, often presenting with overt gastrointestinal bleeding. We report a 57-year-old man with gallstone-related necrotizing pancreatitis complicated by pancreaticoduodenal fistula formation and massive hematochezia. Endoscopy identified a bleeding duodenal lesion, while cross-sectional imaging and mesenteric angiography confirmed pseudoaneurysms arising from pancreaticoduodenal arterial branches. Hemostasis was successfully achieved through coil embolization. Persistent fistula output delayed oral intake and was managed conservatively using postpyloric enteral feeding via an endoscopically placed nasoduodenal tube. The patient remained clinically stable with no recurrence of bleeding and was discharged with planned imaging follow-up. This case highlights the importance of early recognition of vascular complications in necrotizing pancreatitis and demonstrates that a multidisciplinary approach combining endoscopy, interventional radiology, and nutritional support can result in favorable outcomes.