A 56-year-old man was performed a total gastrectomy with regional lymph node dissection for type 4 gastric cancer. On 60th postoperative day, massive hematemesis developed and a splenic artery pseudoaneurysm was found by angiography. We thought that the adventitia of arterial wall was damaged by an agressive dissection of lymph nodes, and postoperative infection around the drainage tube accelerated the formation of pseudoaneurysm. It seemed that the pseudoaneurysm penetrated the jejunal wall and hematemesis ap-peared.
An emergency angiography was performed when the 2nd hematemesis appeared, and the bleeding was successfully stopped by transcatheter arterial embolization. On periodic observation by CT, almost no aneurysm has been revealed.
When a sudden hematemesis appears during postoperative observation of cancer of the upper digestive tract, we consider the possible presence of pseudoaneurysm.