Hepatobiliary and pancreatic surgery: bleeding pancreatic pseudocyst: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Hepatobiliary and pancreatic surgery: bleeding pancreatic pseudocyst

Sample item

A man with a known pancreatic pseudocyst has sudden upper gastrointestinal bleeding with blood coming through the ampulla at endoscopy. CT angiography shows an arterial blush within the cyst. What is the best management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Angiographic embolisation

Erosion of a peripancreatic artery, commonly the splenic or gastroduodenal artery, by pseudocyst enzymes forms a pseudoaneurysm and can bleed into the duct (haemosuccus pancreaticus). Angiographic embolisation controls haemorrhage; drainage before embolisation can provoke catastrophic bleeding.

Option by option

  • A. Endoscopic cystogastrostomy

    Endoscopic drainage is hazardous with an arterial blush in the cavity.

  • B. Angiographic embolisation (correct)

    Correct. Embolisation of the feeding artery is the first-line treatment for a bleeding pseudoaneurysm.

  • C. Percutaneous drainage of the cyst

    Drainage of a cyst containing a pseudoaneurysm risks torrential haemorrhage.

  • D. Octreotide infusion alone

    Octreotide does not control arterial bleeding from a pseudoaneurysm.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is B, Angiographic embolisation. Erosion of a peripancreatic artery, commonly the splenic or gastroduodenal artery, by pseudocyst enzymes forms a pseudoaneurysm and can bleed into the duct (haemosuccus pancreaticus).

Why is "Endoscopic cystogastrostomy" not the answer?

Endoscopic drainage is hazardous with an arterial blush in the cavity.

Why is "Percutaneous drainage of the cyst" not the answer?

Drainage of a cyst containing a pseudoaneurysm risks torrential haemorrhage.

Why is "Octreotide infusion alone" not the answer?

Octreotide does not control arterial bleeding from a pseudoaneurysm.

What concept does this question test?

It tests Hepatobiliary and pancreatic surgery: bleeding pancreatic pseudocyst in General Surgery. Angiographic embolisation controls haemorrhage; drainage before embolisation can provoke catastrophic bleeding.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Hepatobiliary and pancreatic surgery: bleeding pancreatic pseudocyst?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.