Abstract
We present a 45-year-old man with chronic pancreatitis and the rare complication of large subcapsular splenic pseudocyst. He suffered from a slow growing left upper quadrant abdominal distension for 2 weeks and pain radiating to his back. On abdominal computed tomography, large subcapsular splenic pseudocyst (25×13×11 cm), multiple small sized pancreatic pseudocysts in the pancreas tail and chronic pancreatitis with multiple pancreatic stones were shown. He underwent percutaneous catheter drainage of the splenic pseudocyst and after 3 weeks, the size of the pseudocyst decreased. But, the pain radiating to his back and poor oral intake was not improved. Distal pancreatectomy, Roux-en-Y pancreaticojejunostomy, and splenectomy were performed and the patient was discharged after 2 weeks. A splenic subcapsular pseudocyst resulting from pancreatitis may be managed by percutaneous drainage, but according to a patient's clinical symptoms, operative management can be added.
Figures and Tables
![]() | Fig. 1Abdominal CT shows. (A) A large sized splenic subcapsular pseudocyst measuring 25×13×11 cm. (B) Chronic pancreatitis with severe parenchymal atrophy and multiple pancreatic calcification. |
References
1. Fishman EK, Soyer P, Bliss DF, Bluemke DA, Devine N. Splenic involvement in pancreatitis: spectrum of CT findings. AJR Am J Roentgenol. 1995. 164:631–635.
2. Malka D, Hammel P, Levy P, Sauvanet A, Ruszniewski P, Belghiti J, et al. Splenic complications in chronic pancreatitis: prevalence and risk factors in a medical-surgical series of 500 patients. Br J Surg. 1998. 85:1645–1649.
3. Lee YJ, Hwang SH, An DH, Jang YY, Lee GM, Lee DS, et al. A case of intrasplenic pseudocyst complicated by chronic pancreatitis. Korean J Gastroenterol. 2000. 36:716–720.
4. Jang KA, Jin W, Yang DM, Kim HS, Kim HS, Lee HK, et al. Subcapsular hematoma of the spleen from chronic pancreatitis: a case report. J Korean Radiol Soc. 2001. 44:703–705.
5. Lankisch PG. The spleen in inflammatory pancreatic disease. Gastroenterology. 1990. 98:509–516.
6. Mauro MA, Schiebler ML, Parker LA, Jaques PF. The spleen and its vasculature in pancreatitis: CT findings. Am Surg. 1993. 59:155–159.
7. Vyborny CJ, Merrill TN, Reda J, Geurkink RE, Smith SJ. Subacute subcapsular hematoma of the spleen complicating pancreatitis: successful percutaneous drainage. Radiology. 1988. 169:161–162.
8. Tseng CW, Chen CC, Chiang JH, Chang FY, Lin HC, Lee SD. Percutaneous drainage of large subcapsular hematoma of the spleen complicating acute pancreatitis. J Chin Med Assoc. 2008. 71:92–95.
9. Thompson JE Jr, Ashley SW. Subcapsular hematoma of the spleen associated with acute pancreatitis. Surgery. 1997. 121:231–233.
10. Agnifili A, Gianfelice F, Gola P, Guadagni S, Ibi I, Onorato A, et al. Subcapsular splenic hematoma complicating chronic relapsing pancreatitis. Case report. Eur J Surg. 1991. 157:63–65.