Introduction: Upper gastrointestinal bleeding (UGIB) is an uncommon complication of pancreatitis and may be challenging to diagnose when bleeding is intermittent and routine investigations are inconclusive. We report a case of intermittent UGIB associated with a hemorrhagic pancreatic pseudocyst and transient cystoduodenal fistula. Case Presentation: A 29-year-old woman with biliary pancreatitis complicated by necrotizing pancreatitis and recurrent pancreatic collections presented with recurrent pancreatitis and intermittent UGIB. Imaging revealed a hemorrhagic pancreatic pseudocyst. During hospitalization, she experienced three discrete bleeding episodes over 10 days, including hematemesis, coffee-ground emesis, and maroon-colored stools, with a hemoglobin nadir of 7.5 g/dL, requiring transfusion. Esophagogastroduodenoscopy revealed a duodenal bulb mucosal defect consistent with a cyst–duodenal fistula, which healed spontaneously. Repeated computed tomography angiography revealed no active bleeding or evidence of a pseudoaneurysm. Subsequent evaluation revealed pancreatic duct disruption with contrast leakage into a persistent pancreatic collection. Pancreatic duct stenting was performed, after which no further bleeding occurred. Conclusion: This case highlights transient cyst–duodenal fistulization as an underrecognized mechanism of intermittent UGIB in complicated pancreatitis and emphasizes that negative angiography does not exclude the pancreatic source of bleeding.
Fadul et al. (Thu,) studied this question.