Ruptured subcapsular giant hematoma of the spleen as a complication of chronic pancreatitis

Splenic hematoma following acute pancreatitis, and the role of conservative management: A case report

Key clinical message

We reported a unique case in which the patient developed splenic hematoma following acute pancreatitis, the condition responded well to conservative management without any surgical intervention.

Abstract

Splenic hematoma following acute pancreatitis is a rare complication that is thought to be due to the distribution of pancreatic exudates to the spleen. We presented a case of a 44-year-old patient with acute pancreatitis who developed a splenic hematoma. He responded well to conservative management and the hematoma was resolved.

Atraumatic Splenic Hemorrhage as a Rare Complication of Pancreatitis: Case Report and Literature Review

Splenic hemorrhage (hematoma and rupture) is a rare complication of pancreatitis. In this article, we present a rare case of spontaneous splenic rupture as a complication of acute pancreatitis. A literature review was also completed to describe the patient characteristics, associated pancreatitis etiology, clinical presentations, risk factors, diagnostic and treatment modalities, and outcomes.

A rare cause of acute abdomen: Splenic hematoma and rupture resulting from pancreatitis

Splenic subcapsular hematoma and splenic rupture due to pancreatitis are rare causes of acute abdomen. Here we report a case of splenic hematoma and rupture resulting from a second attack of pancreatitis in a 38 year-old woman with chronic pancreatitis due to alcoholism. Her first pancreatitis attack, 4 months before the second, was complicated with a pancreatic pseudocyst that was drained and acute renal failure. The patient underwent pancreatic necrosectomy and splenectomy, and was discharged on the sixth postoperative day without any further complication. We conclude that splenic hematoma, a complication of pancreatitis attack, which may require emergency surgical intervention, must be kept in mind in order to make an early diagnosis. Considering a possible subsequent attack of pancreatitis and determining follow-up criteria, radical treatment must be planned immediately.

Unusual presentation of spontaneous splenic haematoma due to severe pancreatitis: a cautionary tale

We report the case of a patient with multiple splenic complications from chronic pancreatitis with pseudocyst formation, including splenic vein thrombosis, subcapsular splenic haematoma and splenic artery pseudoaneurysm. The initial presentation was associated with pleuritic chest pain, clinically resembling symptoms of pulmonary embolism. The patient was treated with therapeutic low-molecular-weight heparin, without confirmatory imaging. However, the latter arranged computed tomographic pulmonary angiogram was negative, while the abdominal sequences of the CT revealed the splenic haematoma as causative pathology. The patient was initially treated conservatively, and discharged from inpatient care. On a subsequent CT, a pseudoaneurysm of the splenic artery was found and treated with coil embolisation. The patient is currently awaiting definitive management of the pancreatic pseudocyst.

Percutaneous drainage of large subcapsular hematoma of the spleen complicating acute pancreatitis

The splenic complications associated with acute or chronic pancreatitis are rare, including splenic vein thrombosis, arterial pseudoaneurysm, subcapsular splenic hematoma, and splenic rupture. The management for subcapsular splenic hematoma in pancreatitis remains controversial. We herein report a rare case of large subcapsular splenic hematoma complicating acute pancreatitis, which was successfully treated by ultrasound-guided percutaneous drainage. A 32-year-old male suffered from intermittent epigastric pain radiating to his back. Acute pancreatitis complicated with subcapsular splenic hematoma (15.0 x 13.0 x 9.5 cm) was shown on abdominal computed tomography (CT). He underwent ultrasound-guided percutaneous drainage of the splenic hematoma. The size of the splenic hematoma had reduced to 9.5 x 2.3 cm 10 days later. After 4-week drainage of the hematoma, the abdominal pain improved and the patient was discharged. Follow-up abdominal CT 6 months later showed that the subcapsular splenic hematoma had almost completely resolved. The post-drainage course was smooth, and the patient had no abdominal symptoms at the 1-year follow-up.

Percutaneous drainage of spontaneous subcapsular haematoma of the spleen complicating chronic pancreatitis

Subcapsular haematoma of the spleen is a rare complication of chronic pancreatitis. In the literature only a handful of cases have been documented. The exact aetiology and natural history of this complication remains speculative and its management controversial. A case of spontaneous subacute haematoma of the spleen in a patient with chronic relapsing alcohol-related pancreatitis was reported. A percutaneous drainage was performed with good outcome. A review of the literature has demonstrated only one previous similar report.

Splenic complications in chronic pancreatitis: prevalence and risk factors in a medical-surgical series of 500 patients

BACKGROUND

The prevalence, course, treatment, outcome and risk factors of splenic complications in chronic pancreatitis are poorly documented.

METHODS

Patients with splenic complications in a medical-surgical series of 500 consecutive patients with proven chronic pancreatitis prospectively followed up for a mean of 7.0 years were compared with patients without splenic complications.

RESULTS

Eleven men (2.2 per cent) with alcoholic chronic pancreatitis (median duration 2 (range 0-5) years) had a splenic complication: intrasplenic pseudocyst (n=5), subcapsular haematoma (n=2) or splenic rupture (n=4). All patients except one underwent splenectomy, five of whom also underwent distal pancreatectomy. There were no deaths. Patients with splenic complications had pancreatic tail necrosis (six of 11 versus 17.4 per cent; P=0.007), distal pseudocyst (six of 11 versus 11.7 per cent; P=0.0009) or splenic vein occlusion (seven of 11 versus 10.8 per cent; P< 0.0001) more frequently than those without. In the 22 patients with distal pseudocyst and splenic vein occlusion, the prevalence of splenic complications was 18 per cent (odds ratio 15.0 (95 per cent confidence interval 4.0-55.7).

CONCLUSION

Splenic complications occur early in the course of chronic pancreatitis, are rare and are favoured by splenic vein occlusion and pseudocyst or necrosis of the pancreatic tail. Surgical treatment is usually required.