Large Subcapsular Splenic Hematoma with a Large Pancreatic Pseudocyst Was Successfully Treated with Splenic Arterial Embolization and Ultrasound-Guided Percutaneous Drainage of Pancreatic Pseudocyst

Subcapsular splenic hematoma is a rare complication of pancreatitis. The management for subcapsular splenic hematoma remains controversial. We herein report a case of a large subcapsular splenic hematoma with a large pancreatic pseudocyst, which was successfully treated with splenic arterial embolization and ultrasound- (US-) guided percutaneous drainage of pancreatic pseudocyst, for the first time. A 44-year-old male suffered from recurrent abdominal pain for more than two years. He had previous 3 episodes of pancreatitis. A subcapsular splenic hematoma (16.0 × 16.0 × 7.6 cm) with pancreatic pseudocyst (13.5 × 10.0 × 8.0 cm) was shown on abdominal computed tomography (CT). He underwent splenic arterial embolization to decrease the blood supply of the spleen and then ultrasound-guided percutaneous drainage of the large pancreatic pseudocyst. After 2 weeks, the repeated CT-Abdomen showed the disappearance of pancreatic pseudocyst and multiple areas of infarction on the spleen, while the splenic subcapsular hematoma had also significantly reduced. The patient was discharged after almost a month of his hospital admission with the drainage tube attached, and about 2 weeks later the drainage tube was removed upon CT scan confirmation of decrease in the volume of the subcapsular hematoma. Patient had no abdominal symptoms at the 1.5-year follow-up.

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Spontaneous Subcapsular Splenic Hematoma: A Rare Complication of Pancreatitis

The American Surgeon ◽

10.1177/000313480507101217 ◽

2005 ◽

Vol 71 (12) ◽

pp. 1066-1069 ◽

Cited By ~ 5

Author(s):

Vijaykumar G. Patel ◽

Osama M. Eltayeb ◽

Majed Zakaria ◽

James K. Fortson ◽

William L. Weaver

Keyword(s):

Pancreatic Pseudocyst ◽

Rare Complication ◽

Splenic Hilum ◽

Hematoma Formation ◽

Subcapsular Hematoma ◽

Good Outcome ◽

Close Proximity ◽

Splenic Hematoma

Subcapsular hematoma of the spleen is a rare complication of pancreatitis despite its close proximity to the pancreas. Pancreatic pseudocyst involving the tail of the pancreas may erode into the splenic hilum causing hilar vessel bleeding with subcapsular dissection and hematoma formation. The management of such complication is still controversial. It has been suggested that most of these complications spontaneously regress and therefore can be managed conservatively. A case of spontaneous splenic subcapsular hematoma resulting from pancreatitis was managed conservatively with a good outcome.

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Ultrasound-Guided Percutaneous Drainage of Abdominal Collections—An Analysis over 5 Years

Gastroenterology Insights ◽

10.3390/gastroent12030035 ◽

2021 ◽

Vol 12 (3) ◽

pp. 366-375

Author(s):

Madalina Stan-Ilie ◽

Oana-Mihaela Plotogea ◽

Ecaterina Rinja ◽

Vasile Sandru ◽

Andreea Butuc ◽

...

Keyword(s):

Percutaneous Drainage ◽

Personal Experience ◽

Ultrasound Guidance ◽

Clinical Success ◽

Microbiological Analysis ◽

Ultrasound Guided ◽

First Choice ◽

Procedural Complications ◽

Splenic Hematoma ◽

Catheter Replacement

Introduction. Ultrasound-guided (US-guided) percutaneous drainage (PD) of abdominal collections represents the first-choice alternative to surgical intervention. The aim of our study was to assess the efficacy and safety of PD of visceral and non-visceral abdominal collections by reviewing our personal experience over a period of 5 years. Material and methods. The present study included 66 patients who underwent PD under ultrasound guidance. We analyzed clinical variables (collection size, catheter diameter, collection type, microbiological analysis, antibiotic regimens) along with the outcomes of the procedure. Results. Visceral collections were predominant, encompassing 38 hepatic abscesses and 1 splenic hematoma. Microbiological analysis showed that the majority (54%) were monomicrobial. The most encountered pathogens were Klebsiella pneumoniae and Escherichia coli. Technical success was achieved in all cases and clinical success was observed in 84.6% of the cases. No immediate procedural complications were detected. There were 6 patients who needed reinterventions, either by catheter replacement or by surgical treatment. The mortality rate was 4.5%, due to patients’ poor overall status and oncological comorbidities. Conclusions. Percutaneous drainage under ultrasound guidance is a safe and effective procedure in the management of abdominal collections.

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

Korean Journal of Gastroenterology ◽

10.4166/kjg.2011.57.4.258 ◽

2011 ◽

Vol 57 (4) ◽

pp. 258 ◽

Cited By ~ 2

Author(s):

Young-Il Kim ◽

Seon-Young Park ◽

Jeong-Hyeon Lee ◽

Won-Ju Kee ◽

Chang-Hwan Park ◽

...

Keyword(s):

Percutaneous Drainage ◽

Pancreatic Pseudocyst ◽

Splenic Hematoma

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Abscess formation following hydrogel spacer for prostate cancer radiotherapy: a rare complication

BMJ Case Reports ◽

10.1136/bcr-2018-229143 ◽

2019 ◽

Vol 12 (10) ◽

pp. e229143

Author(s):

Venetia Hoe ◽

Henry Han-I Yao ◽

James G Huang ◽

Mario Guerrieri

Keyword(s):

Prostate Cancer ◽

Ct Scan ◽

Percutaneous Drainage ◽

Rare Complication ◽

Abscess Formation ◽

Ct Scans ◽

Ultrasound Guided ◽

Cancer Radiotherapy ◽

Serial Ct ◽

Prostate Cancer Radiotherapy

Periprostatic abscess is a rare complication of hydrogel spacers in radiotherapy for prostate cancer. We present the case of a 61-year-old man who developed this condition. Abdominopelvis CT scan revealed a 54×35×75 mm collection in the location of the SpaceOAR, for which ultrasound-guided transperineal percutaneous drainage of the periprostatic abscess was performed. The patient remains well with serial CT scans showing near resolution of the collection.

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Laparoscopic Debridement of Recurrent Pancreatic Abscesses in the Hostile Abdomen

The American Surgeon ◽

10.1177/000313480607200610 ◽

2006 ◽

Vol 72 (6) ◽

pp. 511-514 ◽

Cited By ~ 1

Author(s):

James M. Haan ◽

Thomas M. Scalea

Keyword(s):

Percutaneous Drainage ◽

Pancreatic Pseudocyst ◽

Pancreatic Necrosis ◽

Irrigation System ◽

Intraoperative Complications ◽

Necrotizing Pancreatitis ◽

Drainage Tube ◽

Necrotic Tissue ◽

Laparoscopic Drainage ◽

Necrotic Debris

Recurrent necrotizing pancreatitis in the frozen or hostile abdomen remains a challenge. Percutaneous drainage is useful in these cases but often fails if there is significant pancreatic necrosis. We describe a technique for laparoscopic drainage of necrotic pancreas. The preexisting percutaneous drainage tract was sequentially dilated and a working thoracoscope was placed via a Hasson cannula. A pulsatile irrigation system was used to open the cavity for visualization and to wash away obvious necrotic debris. Working sequentially using the irrigation jet flow for debridement and visualization, we opened the entire tract and debrided a majority of the necrotic tissue. A large drainage tube was placed to allow the egress of any residual infection. Three patients to date have been treated with the above technique with no intraoperative complications. All three patients did well initially postoperatively and had adequate drainage. One patient developed a delayed pancreatic pseudocyst. Laparoscopic debridement via percutaneous drainage tract is a useful technique in the hostile abdomen.

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Intrahepatic Pancreatic Pseudocyst: a Rare Complication of Pancreatitis

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.263.pje ◽

2017 ◽

Vol 26 (3) ◽

pp. 222

Author(s):

Peter J. Edmonds ◽

Juan Pablo Arroyo ◽

Andre Morales ◽

Ryan M. Brown ◽

Wesley E. Ely

Keyword(s):

Pancreatic Pseudocyst ◽

Rare Complication

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Similar Efficacies of Endoscopic Ultrasound–guided Transmural and Percutaneous Drainage for Malignant Distal Biliary Obstruction

Clinical Gastroenterology and Hepatology ◽

10.1016/j.cgh.2015.12.032 ◽

2016 ◽

Vol 14 (7) ◽

pp. 1011-1019.e3 ◽

Cited By ~ 74

Author(s):

Tae Hoon Lee ◽

Jun-Ho Choi ◽

Do Hyun Park ◽

Tae Jun Song ◽

Dong Uk Kim ◽

...

Keyword(s):

Endoscopic Ultrasound ◽

Percutaneous Drainage ◽

Biliary Obstruction ◽

Ultrasound Guided

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Pancreaticopleural Fistula: A Cause of Recurrent Pleural Effusions in Chronic Pancreatitis

Journal of Gastrointestinal and Abdominal Radiology ◽

10.1055/s-0040-1719222 ◽

2021 ◽

Author(s):

Ayah Megahed ◽

Rahul Hegde ◽

Pranav Sharma ◽

Rahmat Ali ◽

Anas Bamashmos

Keyword(s):

Chronic Pancreatitis ◽

Pancreatic Duct ◽

Pleural Fluid ◽

Rare Complication ◽

Delayed Diagnosis ◽

Magnetic Resonance Cholangiopancreatography ◽

Pleural Effusions ◽

Diagnostic Challenge ◽

Abdominal Symptoms ◽

Pancreatic Duct Stenting

AbstractPancreaticopleural fistula is a rare complication of chronic pancreatitis caused by disruption of the pancreatic duct and fistulous communication with the pleural cavity. It usually presents with respiratory symptoms from recurrent large volume pleural effusions. Paucity of abdominal symptoms makes it a diagnostic challenge, leading often to delayed diagnosis. Marked elevation of pleural fluid amylase, which is not a commonly performed test, is a sensitive marker in its detection. Imaging with magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography can help delineate the fistula. In this report, we present the clinical features, imaging, and management of a 59-year-old male patient with pancreaticopleural fistula, wherein the diagnosis was suspected only after repeated pleural fluid drainages were performed for re-accumulating pleural effusions and it was eventually successfully treated with pancreatic duct stenting. We review the literature with regards to the incidence, presentation, diagnosis, and management of this rare entity.

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