The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지

A case of subcapsular splenic hematoma complicated by alcoholic pancreatitis, improved with conservative care

보존적 치료로 호전된 알코올성 췌장염에 의한 비장피막하혈종 1예

  • Kim, Hee-Jung (Department of Internal Medicine, Kangwon National University College of Medicine) ;
  • Jeong, Dae-Joon (Department of Internal Medicine, Kangwon National University College of Medicine) ;
  • Park, Myeong-Ok (Department of Internal Medicine, Kangwon National University College of Medicine) ;
  • Lee, Sung-Joon (Department of Internal Medicine, Kangwon National University College of Medicine) ;
  • Kang, Chang-Don (Department of Internal Medicine, Kangwon National University College of Medicine) ;
  • Choi, Dae-Hee (Department of Internal Medicine, Kangwon National University College of Medicine)
  • 김희정 (강원대학교 의과대학 내과학교실) ;
  • 정대준 (강원대학교 의과대학 내과학교실) ;
  • 박명옥 (강원대학교 의과대학 내과학교실) ;
  • 이성준 (강원대학교 의과대학 내과학교실) ;
  • 강창돈 (강원대학교 의과대학 내과학교실) ;
  • 최대희 (강원대학교 의과대학 내과학교실)
  • Received : 2009.10.28
  • Accepted : 2009.12.17
  • Published : 2010.12.01
⟨ Previous Next ⟩

Abstract

Splenic complications may occur during the course of pancreatitis, as the pancreas and spleen lie adjacent to each other. However, splenic complications associated with pancreatitis are rare, including splenic vein thrombosis, arterial pseudoaneurysm, subcapsular splenic hematoma, and splenic rupture. The management for subcapsular splenic hematoma with pancreatitis remains controversial. We report a case of a 51-year-old man with alcoholic pancreatitis and the rare complication of a large subcapsular splenic hematoma, which was managed conservatively with a good outcome.

췌장염이 있을 때 췌장과 비장의 인접한 위치와 해부학적인 연속성 때문에 드물게 비장피막하혈종이 생길 수 있다. 치료는 비장절제술, 경피적 도관 배액술 및 보존요법이 있는데 저자들을 혈역학적으로 안정한 환자에게 보존적 치료를 통해 호전된 경우를 1예 경험하였기에 문헌고찰과 함께 보고하는 바이다.

Keywords

References

  1. Fishman EK, Soyer P, Bliss DF, Bluemke DA, Devine N. Splenic involvement in pancreatitis: spectrum of CT findings. AJR Am J Roentgenol 164:631-635, 1995 https://doi.org/10.2214/ajr.164.3.7863884
  2. Jang KA, Jin W, Yang DM, Kim HS, Kim HS, Lee HK, Yang HJ. Subcapsular hematoma of the spleen from chronic pancreatitis: a case report. J Korean Radiol Soc 44:703-705, 2001
  3. Han YS, Joo DH, Choi DL. Large subcapsular pseudocyst of spleen complicated by chronic pancreatitis. J Korean Surg Soc 76:131-134, 2009 https://doi.org/10.4174/jkss.2009.76.2.131
  4. Lankisch PG. The spleen in inflammatory pancreatic disease. Gastroenterology 98:509-516, 1990 https://doi.org/10.1016/0016-5085(90)90848-U
  5. Sitzmann JV, Imbenbo AL. Splenic complications of a pancreatic pseudocyst. Am J Surg 147:191-196, 1984 https://doi.org/10.1016/0002-9610(84)90087-4
  6. Vyborny CJ, Merrill TN, Reda J, Geurkink RE, Smith SJ. Subacute subcapsular hematoma of the spleen complicating pancreatitis: successful percutaneous drainage. Radiology 169:161-162, 1988 https://doi.org/10.1148/radiology.169.1.3420253
  7. Tseng CW, Chen CC, Chiang JH, Chang FY, Lin HC, Lee SD. Percutaneous drainage of large subcapsular hematoma of the spleen complicating acute pancreatitis. J Chin Med Assoc 71:92-95, 2008 https://doi.org/10.1016/S1726-4901(08)70081-9
  8. Thompson JE Jr, Ashley SW. Subcapsular hematoma of the spleen associated with acute pancreatitis. Surgery 121:231-233, 1997 https://doi.org/10.1016/S0039-6060(97)90297-X
  9. Malka D, Hammel P, Levy P, Sauvanet A, Ruszniewski P, Belghiti J, Bernades P. Splenic complications in chronic pancreatitis: prevalence and risk factors in a medical–surgical series of 500 patients. Br J Surg 85:1645-1649, 1998 https://doi.org/10.1046/j.1365-2168.1998.00952.x
  10. Hastings OM, Jain KM, Khademi M, Lazaro EJ. Intrasplenic pancreatic pseudocyst complicating severe acute pancreatitis. Am J Gastroenterol 69:182-186, 1978
  11. Kuramitsu T, Komatsu M, Ono T, Nakajima K, Funaoka M, Kato J, Naganuma H, Ishida H, Masamune O. Ruptured subcapsular giant hematoma of the spleen as a complication of chronic pancreatitis. Intern Med 34:564-568, 1995 https://doi.org/10.2169/internalmedicine.34.564
  12. Rypens F, Deviere J, Zalcman M, Braude P, Van de Stadt J, Struyven J, Van Gansbeke D. Splenic parenchymal complications of pancreatitis: CT findings and natural history. J Comput Assist Tomogr 21:89-93, 1997 https://doi.org/10.1097/00004728-199701000-00016
  13. Patel VG, Eltayeb OM, Zakaria M, Fortson JK, Weaver WL. Spontaneous subcapsular splenic hematoma: a rare complication of pancreatitis. Am Surg 71:1066-1069, 2005