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Case Reports
. 2017:2017:6381479.
doi: 10.1155/2017/6381479. Epub 2017 Aug 22.

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

Song Zhang  1 , Fei Liu  1 , Heena Buch  1 , Guifang Xu  1 , Lei Wang  1
Affiliations
Case Reports

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

Song Zhang et al. Case Rep Med. 2017.

Abstract

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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Figures

Figure 1
Figure 1
CT scan showing a large subcapsular splenic hematoma (16.0 × 16.0 × 7.6 cm) with a large pancreatic pseudocyst (13.5 × 10.0 × 8.0 cm).
Figure 2
Figure 2
CT scan showing a large subcapsular splenic hematoma with a large pancreatic pseudocyst.
Figure 3
Figure 3
Vascular restructure with CT showing splenic vein dilation and expansion of portal vein branches.
Figure 4
Figure 4
CT showing the drainage tube was in place, but splenic subcapsular hematoma had no change.
Figure 5
Figure 5
Showing coil embolization of splenic artery.
Figure 6
Figure 6
After US-guided percutaneous puncture drainage of pancreatic pseudocyst, X-ray showing drainage tube was in the right place.
Figure 7
Figure 7
About 2 weeks after splenic artery embolization and ultrasound-guided percutaneous drainage of pancreatic pseudocyst, CT showing the disappearance of pancreatic pseudocyst, multiple areas of infarction on the spleen, and the significant reduction of splenic subcapsular hematoma.
Figure 8
Figure 8
CT scan showing the volume of splenic subcapsular hematoma significantly reduced compared to all previous images.
See this image and copyright information in PMC

References

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