A Case with Pancreatic Cancer Initially Detected As A Subcapsular Splenic Hematoma

Yukio Tamura¹⁾, Shigeru Sato¹⁾, Natsuya Katada¹⁾, Hiroshi Sasamoto¹⁾, Shinichi Sakuramoto²⁾, Yoshiki Hiki²⁾, Akira Kakita²⁾ and Hiroshi Nishimaki³⁾

Department of Surgery, Sagamidai Hospital¹⁾
Department of Surgery²⁾ and Radiology³⁾,
Kitasato University

We report a case of pancreatic cancer which was initially detected as a subcapsular splenic hematoma and was surgically resected. A 48-year-old man who complained of upper abdominal pain and constipation was admitted to our department. Computed tomography (CT) showed a hematoma in the lateral part of the spleen. We diagnosed it as a subcapsular splenic hematoma of unknown origin and performed a lapalotomy. A subcapsular splenic hematoma and intraperitoneal abscess were noted and abdominal lavage and drainage were performed. After the surgery, the inflammatory reaction and serum amylase continued to be at a high level according the laboratory findings and the pancreatic juice was drained from the incised splenic capsule site. Three months after surgery CT showed a mass 12 mm in size at the pancreatic head. An endoscopic retrograde pancreatogram showed that the main pancreatic duct was stenotic and the second branch of the pancreatic duct was encased at the pancreatic head, and the distal pancreatic duct was dilated. These finding strongly suggested chronic pancreatitis and pancreatic head cancer and pacreatoduodenectomy was performed. The operative findings revealed a pancreatic tumor with 2.0×1.5-cm and advanced pancreatic cancer of stage III. The subcapsular splenic hematoma in this case was due to pancreatitis as a complication of pancreatic cancer. In such a case, an appropriate assessment of the etiology can support early detection followed by early resection of pancreatic cancer.

Key words
subcapsular splenic hematoma, pancreatic carcinoma, chronic pancreatitis

Reprint requests
Yukio Tamura Department of Surgery, Kitasato University, School of Medicine 1-15-1 Kitasato, Sagamihara, 228-8555 JAPAN

Accepted
December 9, 1998

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