Korean J Gastroenterol.  2011 Apr;57(4):258-261. 10.4166/kjg.2011.57.4.258.

A Case of Pancreatic Pseudocyst with a Large Subcapsular Splenic Hematoma Treated Successfully by Ultrasonography-guided Percutaneous Drainage

• Kim YI
• Park SY
• Lee JH
• Kee WJ
• Park CH
• Kim HS
• Choi SK
• Rew JS

• KMID: 1718408
• DOI: http://doi.org/10.4166/kjg.2011.57.4.258

Abstract

A subcapsular splenic hematoma is a very rare hemorrhagic complication of pancreatitis. We report here on a case of pseudocyst with a large subcapsular splenic hematoma in a 43-year-old man who presented with severe left flank pain for one week. Despite the initial conservative treatment consisting of pain control, bowel rest, intravenous fluids and antibiotics, the pain was not relieved. An abdominal computed tomography (CT) was performed, and it showed a pseudocyst that was increasing in size with a large subcapsular splenic hematoma measuring 6x13 cm compared to the images at admission. Ultrasonography (US)-guided percutaneous drainage was performed without any complications, and splenectomy was avoided. After the discharge, the patient remained asymptomatic for eight months. We suggest that percutaneous drainage of a large subcapsular hematoma complicating pancreatitis might be a useful treatment option in selected patients.

Keyword

Subcapsular splenic hematoma; Pancreatitis; Pseudocyst; Drainage

MeSH Terms

Adult
*Drainage
Hematoma/complications/*therapy/ultrasonography
Humans
Male
Pancreatic Pseudocyst/*therapy/ultrasonography
Pancreatitis/complications
Splenic Diseases/*therapy/ultrasonography
Tomography, X-Ray Computed

Figure

• 

  Fig. 1. Computed tomographic (CT) scan images during the second episode of pancreatitis and in the emergency room. (A) Variable sized multiple pseudocysts in the tail of the pancreas compressed the adjacent structures including splenic vein, gastric fundus (arrow), and splenic parenchyma (arrow heads). (B) A CT scan showed increased size of the pseudocyst with a large subcapsular splenic hematoma (arrows) measuring 5×12 cm in the tail of pancreas.

• 

  Fig. 2. CT scan images on hospital day 6 and 3 weeks after US-guided drainage. (A and B) increased size (approximately 6×13 cm) of the psedocyst with subcapsular splenic hematoma is shown (arrows and arrow heads). (C and D) CT images 3 weeks after US-guided percutaneous drainage, the size of the pseudocyst with subcapsular splenic hematoma was markedly decreased. A drainage catheter is shown (arrow head).

Reference

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