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

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 6×13 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. (Korean J Gastroenterol 2011;57:258-261)

Prognostic Factors for Node-Negative Advanced Gastric Cancer after Curative Gastrectomy

“…There are only a few reports on node-negative advanced gastric cancer, and the most recent have focused on lymphatic invasion. 8 9 Chemotherapy is currently not indicated for gastric cancers at a stage of less than T3 without LN metastasis. 10 The aim of this study was to determine the clinicopathological characteristics of and prognostic factors for LN-negative advanced gastric cancer (T2~4N0M0).…”

Comparison of the 6th and 7th editions of the AJCC/UICC TNM staging system for gastric cancer focusing on the “N” parameter-related survival: the monoinstitutional NodUs Italian study

“…According to the new TNM edition, N categories were so redefined in order to improve their reproducibility and prognostic validity: the previous N1 category (1–6 involved regional lymph nodes) is amended into a new N1 category (1–2 involved regional lymph nodes) and N2 category (3–6 involved regional lymph nodes), whereas the previous category N2 (7–15 involved regional lymph nodes) and the N3 category (>15 involved regional lymph nodes) are combined into the new N3 categories (N3a: 7–15 involved regional lymph nodes, and N3b: ≥16 involved regional lymph nodes) [ 2 , 11 ]. In the medical literature, there are a large number of Asian population studies that examine the difference between the 6th and the 7th TNM [ 2 , 11 , 13 – 15 ]; however, gastric cancer in Western countries represents a different disease considering the pattern of presentation and pathophysiology [ 16 – 18 ]. Indeed, studies aimed at validating the new staging criteria focusing on the N category in the Italian population are poor [ 19 ].…”

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

“…Olgumuzda da gördügümüz gibi pankreatit sonrasi meydana gelen splenik subkapsüler hematomun etiyolojisini ortadan kaldirmadan, travmatik veya diger splenik hematomlar ile ayni parametreler ile izlenmesi-nin ve olasi pankreatit atagmi beklemenin uygun olmadigi, spienik rüptür riskinin göz ardí edilmemesi gerektigi kamsindayiz. Literatürde kronik pankreatitli hastalarda büyük spienik hematomun perkutan drenajinm bafari ile yapilmif oldugu ve spienektominin önüne geçtigi olgu sunumiari da mevcuttur (2,6,11). Spienik subkapsüler koleksiyon için perkutan drenaj uygulanabilir bir tedavi olabilir, ancak olgu seçimierinde hemodinamik stabiliteye ve enfeksiyon parametrelerine dikkat edilmelidir.…”