Pancreatic Pseudoaneurysm Identified as Source of Gastrointestinal Bleed on Tc-99m Red Blood Cell Scintigraphy

A 42-year-old woman with a history of acute pancreatitis presented to the emergency room with recurrent gastrointestinal bleeding. CTA of the abdomen and pelvis demonstrated a small focus of enhancement within the pancreatic head suggestive of a pseudoaneurysm. Follow-up Tc-99m labeled RBC scintigraphy demonstrated increased radiotracer uptake in the right upper quadrant with progression through the proximal small bowel, consistent with an active upper GI bleed. Subsequent angiography demonstrated the pancreatic pseudoaneurysm as the source of bleeding, a rare but potentially life-threatening complication of pancreatitis. Endovascular coil embolization was then performed leading to resolution of the patient’s symptoms.