Massive Upper-Gastrointestinal Hemorrhage Due to Pancreatitis

MASSIVE upper-gastrointestinal bleeding that occurs during an episode of pancreatitis presents a special diagnostic and therapeutic challenge. While most cases of mild or moderate hematemesis that occur during an episode of pancreatitis may be due to an associated gastritis, peptic ulcer disease, or ruptured esophageal varices, severe bleeding is more likely to be due to erosion of a large retroperitoneal vessel.^1,2 Such cases have been considered rare, and have not often been diagnosed clinically. The purpose of this paper is to report two additional cases of massive upper-gastrointestinal bleeding due to pancreatitis and to discuss the salient features of these and previously reported cases. Since most of these cases were discovered during postmortem examination, attention is directed to clues which may, in the future, enable the clinician to suspect the correct diagnosis and institute more effective therapy.

Report of Cases 

Case 1.  —This 60-year-old woman entered the hospital complaining