Splenic Pseudocyst and Abscess: A Rare Complication of Chronic Pancreatitis

Author(s):

Joshua Sumislawski; Robert Torphy; Ana Gleisner; Lisa Ferrigno

Background:

Despite its proximity to the pancreas, the spleen is rarely affected in chronic pancreatitis. Splenic pseudocysts have been reported but seldom with superimposed infection. We present a splenic pseudocyst and abscess that resulted from decompression of a strictured pancreatic duct in a patient with chronic pancreatitis.

Hypothesis:

(Not applicable)

Methods:

A 57-year-old male with chronic pancreatitis presented with a one-week history of epigastric pain that resembled previous exacerbations except that it radiated to his left flank and shoulder. He was afebrile but tachycardic with left upper quadrant tenderness, a leukocytosis of 20.7, and a normal lipase. Computed tomography suggested a splenic injury with a fracture and subcapsular hematoma (image 1). With no preceding trauma, endoscopic retrograde cholangiopancreatography was performed to evaluate the pancreatic duct, which was strictured and had decompressed into the subcapsular space of the spleen (image 2).

Results:

After splenic artery embolization, the patient underwent distal pancreatectomy and splenectomy. The spleen was enlarged with multiple purulent fluid collections, which grew Aggregatibacter aphrophilus, Klebsiella pneumoniae, and Prevotella species. The patient was discharged home on postoperative day 6 and completed a three-week course of intravenous antibiotics.

Conclusions:

Although pancreatic pseudocysts are not uncommon in chronic pancreatitis, extension into the splenic parenchyma is rare and can present with superimposed infection requiring surgical drainage.