J Korean Surg Soc.  2009 Feb;76(2):131-134. 10.4174/jkss.2009.76.2.131.

Large Subcapsular Pseudocyst of Spleen Complicated by Chronic Pancreatitis

• Han YS
• Joo DH
• Choi DL

• KMID: 2211277
• DOI: http://doi.org/10.4174/jkss.2009.76.2.131

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 (25x13x11 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.

Keyword

Spleen; Pseudocyst; Pancreatitis

MeSH Terms

Catheters
Drainage
Humans
Middle Aged
Pancreas
Pancreatectomy
Pancreatic Pseudocyst
Pancreaticojejunostomy
Pancreatitis
Pancreatitis, Chronic
Spleen
Splenectomy

Figure

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  Fig. 1 Abdominal 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.

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  Fig. 2 Abdominal CT demonstrates an almost resolved splenic subcapsular pseudocyst, 3 weeks after percutaneous drainage.

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  Fig. 3 Gross findings of the spleen. Large splenic subcapsular pseudocyst was almost resolved and replaced to the inflammatory debris and granulation tissue.

Reference

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.