A rare cause of acute abdomen: splenic hematoma and rupture resulting from pancreatitis

Abstract

Splenic subcapsular hematoma and splenic rupture due to pancreatitis are rare causes of acute abdomen. Here we report a case of splenic hematoma and rupture resulting from a second attack of pancreatitis in a 38 year-old woman with chronic pancreatitis due to alcoholism. Her first pancreatitis attack, 4 months before the second, was complicated with a pancreatic pseudocyst that was drained and acute renal failure. The patient underwent pancreatic necrosectomy and splenectomy, and was discharged on the sixth postoperative day without any further complication. We conclude that splenic hematoma, a complication of pancreatitis attack, which may require emergency surgical intervention, must be kept in mind in order to make an early diagnosis. Considering a possible subsequent attack of pancreatitis and determining follow-up criteria, radical treatment must be planned immediately.

Atraumatic Splenic Hemorrhage as a Rare Complication of Pancreatitis: Case Report and Literature Review

“…Cases related to pseudo-aneurysm rupture, previous procedure or surgery, and abdominal trauma were excluded. The search yielded 19 case reports [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] and 5 case series. [32][33][34][35][36] However, we included one case with splenic artery pseudo-aneurysm, as it did not rupture and therefore was not considered as the cause of splenic hematoma.…”

“…14,20,30 Among the acute pancreatitis cases, 20% (5/25) demonstrated known medical history or imaging evidence of chronic pancreatitis. 19,22,32,33,35 More than half of the cases (53.6%, 15/28) had prior episodes of pancreatitis; six cases had one prior episode; 14,16,20,29,32,36 one case had two prior episodes; 18 our case had three prior episodes; and seven cases had multiple (exact number not defined by individual study authors) prior episodes. 21,24,25,[34][35][36]…”

“…The majority (78.6%) were men. Out of the 28 cases, 89.3% (25/28) presented with acute pancreatitis, 13,[15][16][17][18][19][21][22][23][24][25][26][27][28][29][31][32][33][34][35][36] while 10.7% (3/28) presented with chronic pancreatitis. 14,20,30 Among the acute pancreatitis cases, 20% (5/25) demonstrated known medical history or imaging evidence of chronic pancreatitis.…”

“…The leading etiology of pancreatitis complicated by splenic rupture was alcohol consumption (67.9%, 19/28). [13][14][15][16]18,19,21,23,[26][27][28][29][30][33][34][35][36] Of the remaining cases, 7.1% (2/28) were idiopathic; 36 3.6% (1/28) were related to Crohn' s disease; 17 and 21.4% (6/28) had no specified etiology. 20,22,24,25,31,32…”

Catastrophic Thrombotic Thrombocytopenic Purpura Accompanying Recurrent Acute Pancreatitis Attacks and Splenic Vein Rupture

“…These complications are splenic vein thrombosis, arterial pseudoaneurysm, intrasplenic pancreatic pseudocyst and splenic rupture and are encountered in 1-5% of the cases (18). Cases of splenic rupture due to pancreatitis have been reported, though rarely (19,20). In addition, there have been cases of splenic vein rupture during pregnancy and the puerperium (21).…”