Splenic pseudocyst are uncommon and thought to result from resolution and liquefaction
of hematoma of remote or recent trauma. GSK1120212 Here we represent a case of a huge splenic pseudocyst which is accompanied by a pancreatic pseudocyst. Methods: A 55-year-old man, who had a 30-year history of alcohol consumption and just discontinued 2 years ago, was admitted to our hospital for treatment of aching pain over left upper quadrant (LUQ) of the abdomen, which was worsening after meal without nausea or vomiting. He denied any medical or surgical history, but the patient mentioned a fracture of the left 10th rib eight years ago, without any medical observation after it. The physical examination was essentially normal. The patient’s complete blood count showed an elevated leukocyte count of 14.46×109/L with the neutrophil count of 12×109/L and a slightly decreased erythrocyte count of 3.6×1012/L with hemoglobin 106 g/L. Other blood tests were unremarkable. Ultrasonography (UG) revealed a complex cyst 11–12 cm in diameter on the lower part of the spleen, which contained thick echoes from tissue debris and was loculated
incompletely (Figure 1A). The consistency of the splenic inferior edge was interrupted and the shape of the spleen was irregular. The parenchyma of the spleen was compressed, displaced and found around the complex cyst. The main splenic artery and vein selleck compound and their branches could be demonstrated at the splenic hilum. The shape, size and echogenicity of pancreas (head, body and tail) seemed normal (Figure 1B). The abdominal computed tomography (CT) indicated the lesion in the spleen and splenic hilum, similar to what had beem found in UG. CT revealed an irregular, hypodense cystic lesion in the spleen and around the splenic hilum, part of which was not separated from the tail of pancreas and stomach. The head and body of pancreas were homogenous with the normal size and shape. The contour of the tail of pancreas was unclear (Figure 上海皓元医药股份有限公司 2A). Because of persistent LUQ pain, the patient underwent an exploratory laparotomy. During the operation,
surgeons found a huge cystic mass among the gastric fundus, pancreatic tail and spleen, which was encapsulated by greater omentum and indistinguishable from adjacent tissues, thus leading to the dilemma that it was impossible to remove the cyst integrally. Then the cystic content was aspirated to check amylase, which was black-brown and turbid and showed the level of amylase being as high as 86464 IU/L. Finally, a drainage catheter was placed in the cyst and abdomen was closed. Five days after operation, UG revealed distinctly decreased splenic pseudocyst (Figure 2B, the white arrow points towards the catheter). The pancreas echogenicity (including the tail) seemed as normal as preoperative examination.