Pancreatic Pseudocysts Complicated by Splenic Parenchymal Involvement: Results of Operative and Percutaneous Management

Abstract

Pancreatic pseudocysts complicated by splenic parenchymal involvement may have life-threatening clinical presentations and respond poorly to percutaneous drainage. Distal pancreatectomy and splenectomy are effective, but the complication rate is high.

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

“…3 In the case re- Kuramitsu et al 2 suggested that a large splenic hematoma, larger than 5 cm, complicating pancreatitis should be treated with pressure reduction by percutaneous drainage at an early stage or a laparotomy, even if the clinical course had temporarily improved. However, the serious complications associated with surgical treatment such as bleeding and infections, 12 and distal pancreatitis may predispose patients to the development of diabetes mellitus. 4 In conclusion, US-guided percutaneous drainage was a useful treatment option for the subcapsular splenic hematoma complicating a pancreatic pseudocyst in a patient with multiple episodes of pancreatitis.…”

Pseudocisto pancreático com envolvimento esplênico: relato de caso

“…Thus, some authors advocate early surgical indication due to the greater potential for complications that its evolution may result in 4 . For most authors, the definitive treatment is splenectomy with distal pancreatectomy 1,3 , although prone to complications such as bleeding and infection. Heider 3 presented a review of 238 pseudocysts and found only 14 (6%) of them affecting the spleen.…”

“…For most authors, the definitive treatment is splenectomy with distal pancreatectomy 1,3 , although prone to complications such as bleeding and infection. Heider 3 presented a review of 238 pseudocysts and found only 14 (6%) of them affecting the spleen. This author believes that percutaneous drainage is not effective, since three of them required repetition of the procedure and many others ended up being operated.…”

“…Other unusual cases found in the literature report leaks to distant sites such as the neck, mediastinum, chest cavity and scrotum 2 . The spleen, although very close to the pancreas, is rarely involved in this process and until 2001 there were fewer than 50 cases reported in the English scientific literature 3 . Heavy bleeding from the spleen is the most common and most serious outcome and may require urgent surgical treatment.…”

Quando e como tratar as complicações na necrose pancreática infectada

“…If goes to the peritoneal cavity can cause peritonitis and determine the performance of laparotomy for the cleaning of the cavity 28,38 . If the break occurs inside an organ, usually to the stomach or duodenum and is not associated with bleeding, it may represent the solution to the problem 2,13 .…”