Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2019; 7(23): 4157-4162
Published online Dec 6, 2019. doi: 10.12998/wjcc.v7.i23.4157
Management of massive fistula bleeding after endoscopic ultrasound-guided pancreatic pseudocyst drainage using hemostatic forceps: A case report
Nan Ge, Si-Yu Sun
Nan Ge, Si-Yu Sun, Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
Author contributions: Ge N and Sun SY contributed to study planning and manuscript drafting.
Informed consent statement: Consent was obtained from the relatives of the patient.
Conflict-of-interest statement: All authors declare no conflict of interests for this article.
CARE Checklist (2016) statement: The guidelines of the CARE Checklist (2016) have been adopted.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Si-Yu Sun, MD, PhD, Chief Doctor, Director, Professor, Endoscopy Center, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang 110004, Liaoning Province, China. sunsy@sj-hospital.org
Telephone: +86-18940258105 Fax: +86-24-23892617
Received: September 5, 2019
Peer-review started: September 5, 2019
First decision: October 24, 2019
Revised: November 1, 2019
Accepted: November 14, 2019
Article in press: November 14, 2019
Published online: December 6, 2019
Abstract
BACKGROUND

Endoscopic ultrasound (EUS)-guided drainage is the optimal method for treatment of pancreatic fluid collections (PFCs), and is associated with ease, safety, and efficiency. Bleeding is one of the main procedure-related complications, and often requires surgery or radiologic interventions. Indeed, endoscopic management of this complication is limited.

CASE SUMMARY

A 42-year-old man presented for evaluation of abdominal pain and distention for approximately 2 wk. Abdominal computed tomography revealed a pancreatic pseudocyst located in the tail of the pancreas. EUS-guided pancreatic pseudocyst was performed. After stent placement, massive bleeding was noted from the fistula. Finally, hemostasis was successfully achieved using hemostatic forceps within the fistula.

CONCLUSION

Bleeding vessel grasp and coagulation may represent a successful treatment for a fistula hemorrhage during EUS-guided drainage for a PFC, which may be tried before application of balloon or stent compression.

Keywords: Pancreatic fluid collections, Endoscopic ultrasound, Drainage, Hemorrhage, Case report

Core tip: We report the successful management of massive fistula bleeding during endoscopic ultrasound-guided pancreatic pseudocyst drainage using hemostatic forceps within the fistula, which proved the efficiency of this method.