A Case of Mucinous Cystadenocarcinoma of the Pancreas with Splenic Abscess and Fistula between the Splenic Abscess and the Colon

Manabu Nishiwaki, Kazuhiko Nakagawa, Ryuichiro Yagyu, Kenji Koishi, Koji Nakao, Takashi Inoue, Yoshinori Fujiwara, Takehira Yamamura and Takashi Nishigami*

Second Department of Surgery, Second Department of Pathology*, Hyogo College of Medicine

A 65-year-old woman was admitted for fever for 5 months on January 8, 2003, had undergone US-guided drainage twice for a right subphrenic abscess in April and June 2002 under a diagnosis of right subphrenic abscess, splenic abscess, and abscess in the front of the tail of the pancreas of unknown origin. CT showed low-density lesions representing abscesses within the spleen and intraperitoneal cavity (front of the tail of the pancreas and umbilical region) and a normal pancreas. After US-guided drainage of the splenic abscess and intraperitoneal abscess in the umbilical region, her symptom improved. To confirm the presence of a fistula between the splenic abscess and the splenic flexure of the colon (spleno colonic fistula) and stricture of the transverse colon, we conducted splenectomy and partial resection of the colon. On gross examination, perisplenic inflammation was severe for a splenic abscess, the inferior aspect of the spleen adhered to the transverse colon, and the pancreas was normal. Histological examination showed splenic abscess and mucinous cystadenocarcinoma arising from the distal aspect of the tail of the pancreas extending into the splenic hilum. Metastatic tumor cells also appeared in the wall of the colon surrounding the spleno colonic fistula and the wall of the abscess near the tail of the pancreas. Splenic abscess associated with pancreatic cancer is rare and this is the ninth case in the literature.

Key words
splenic abscess, pancreatic cancer, spleno colonic fistula

Reprint requests
Manabu Nishiwaki Second Department of Surgery, Hyogo College of Medicine
1-1 Mukogawa-cho, Nishinomiya, 663-8501 JAPAN

Accepted
September 22, 2004

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