Splenic Subcapsular Hematoma Complicating a Case of Pancreatitis

Abstract

Splenic subcapsular hematoma is a rare complication of pancreatitis. The splenic vessels and the pancreatic tail lie close together in the lienorenal ligament. The pathologies in the pancreatic tail may occasionally affect the spleen resulting in splenic vein thrombosis, arterial pseudoaneurysm, subcapsular splenic hematoma, and splenic rupture. A 40-year-old male with a history of alcohol abuse and alcohol-induced pancreatitis presented with severe epigastric abdominal pain and was diagnosed with pancreatitis. Later during hospitalization he became dyspneic and hemodynamically unstable, with acute anemia requiring blood transfusion. An abdominal CT with angiography (CTA) revealed a splenic subcapsular hematoma with active bleeding which was managed by urgent exploratory laparotomy and splenectomy. Due to its rarity, diagnosis of splenic hematoma in pancreatitis is challenging with rapid identification and intervention being key to management.

A Rare Case of Atraumatic Splenic Rupture Due to Chronic Pancreatitis

“…Whenever the hemodynamic status is stable and the etiological factors are evident, the conservative approach, with percutaneous drainage and/or splenic artery embolization, can be weighted, provided that there is strict monitoring with serial ultrasound or CT scans [ 2 , 13 , 15 , 17 , 18 ]. Arterial embolization creates an area of infarction of less than 50% of the splenic volume and can be applied for both etiological diagnosis and treatment of bleeding.…”

Akute nekrotisierende Pankreatitis mit hämorrhagischem Schock bei sekundärer Milzruptur: Ein Fallbericht und Literaturübersicht

“…Eine Literaturrecherche nach den Schlüsselwörtern „pancreatitis“, „splenic rupture“ und „splenic hematoma“ in Pubmed, MEDLINE und Google Scholar von Januar 2012 bis August 2022 ergab 21 publizierte Fallberichte, welche sich mit dem Thema beschäftigt haben 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 . Hierbei erfolgte in den meisten Fällen eine offene Laparotomie mit Splenektomie.…”