SHM Converge Scientific Abstract ePoster Gallery-Spink and You'll Miss It: Pancreatic Pseudocyst Invasion

Pdf Summary

A 35-year-old man with SPINK-1–associated hereditary pancreatitis and a known pancreatic pseudocyst presented with hematemesis. Initial evaluation showed a 3 cm ulcerated polypoid lesion in the stomach with signs of recent bleeding, but biopsy and histology were negative for H. pylori and malignancy. Endoscopic ultrasound suggested the cyst was invading the stomach and abutting the splenic vein, and CT angiography later confirmed a pancreatic tail cystic mass with hemorrhagic conversion bulging into the stomach and loss of tissue planes between the stomach and pancreas.  <br /><br />The case highlights a rare complication of hereditary pancreatitis: pseudocyst invasion causing gastric bleeding. Hereditary pancreatitis, often linked to mutations such as SPINK-1, increases risk for complications including pseudocysts and pancreatic cancer. Although hemorrhage from pancreatic pseudocysts is known, bleeding into the stomach and possible splenic vein involvement are exceptionally uncommon.  <br /><br />The patient was advised to undergo distal pancreatectomy, splenectomy, and partial gastrectomy, but initially declined. One year later, he returned with hemoperitoneum and hemorrhagic transformation of the pseudocyst. Arteriography showed no pseudoaneurysm or active extravasation. He then underwent definitive surgery, and pathology confirmed a benign hemorrhagic pseudocyst with chronic pancreatitis.  <br /><br />Key clinical lessons are to maintain suspicion for pseudocyst invasion in hereditary pancreatitis, obtain tissue diagnosis to exclude malignancy, and refer early to centers with advanced endoscopy and multidisciplinary surgical expertise.

Asset Subtitle

Samy Ataya

Meta Tag

Author List Abena Minta, James Stock, Samy Ataya, Thomas Gao

Category Clinical Vignettes

Concept Hereditary Pancreatitis

Concept Pseudocyst

Concept Retinal Hemorrhage

Concept Upper Gastrointestinal Bleeding

Concept SPINK1

Distinguished Non-Finalist

Presenter Organization The Ohio State University

Presenting Author Samy Ataya

Track Adult

Keywords

hereditary pancreatitis

SPINK-1 mutation

pancreatic pseudocyst

gastric bleeding

hematemesis

hemorrhagic pseudocyst

splenic vein involvement

distal pancreatectomy

splenectomy

partial gastrectomy

Hereditary Pancreatitis

Pseudocyst

Retinal Hemorrhage

Upper Gastrointestinal Bleeding

SPINK1