History of Present Illness:

A woman in her late 30s with a history of pancreatitis complicated by pseudocyst formation presents to the ER for abdominal pain and vomiting.  The most recent emesis had a little blood in it.  She denies melena, fever or other complaints

Vital Signs & Physical Exam:

Vital signs are normal except for

Initial Diagnostic Testing:

  • CBC:
  • LFTs:
  • Imaging:

Images courtesy of Ben S. Schillinger, PA-C

What is the most likely diagnosis?

  • A) necrotizing pancreatitis
  • B) ruptured pseudocyst
  • C) arterio-enteric fistula
  • D) pancreatitis with Mallory-Weiss tear

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What is the most likely diagnosis?

  • A) necrotizing pancreatitis
  • B) ruptured pseudocyst
  • C) arterio-enteric fistula – CORRECT
  • D) pancreatitis with Mallory-Weiss tear

 

1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

 

 

CASE CONCLUSION: Diagnosed with a pseudoaneurysm off the left gastric artery with hemorrhage into the pancreatic pseudocyst and stomach.  The left gastric artery was embolized by IR with successful exclusion of the pseudoaneurysm