A Case of Cancer of the Pancreatic Tail with Splenic Infarction and Abscess Causing Diffuse Peritonitis

Kei Yonezawa, Jun Nakagawa, Toshihiko Gotoh, Motoko Harigai, Toshiki Kobayashi, Takuo Takehana, Masato Maeda, Toshiaki Moriki* and Tadashi Miyashita

Department of Surgery and Department of Pathology*, Shizuoka City Shizuoka Hospital

We report a case of splenic infarction and abscess associated with pancreatic tail cancer. A 53-year-old man whose month-long dull pain from the left hypogastric lesion to the left flank had become intolerable and who had developed abdominal muscular defense was found in abdominal computed tomography (CT) to have abscess-like lesions by the pancreatic tail and an infarction and abscess of the spleen, necessitating emergency laparotomy. The abdominal cavity had purulent ascites and the pancreatic tail had indurated and infiltrated into the spleen and the transverse colon, indicating carcinoma. The spleen contained infarction and an abscess that appeared to be the source of the purulent ascites. En bloc resection was avoided due to its diffuse retroperitoneal invasion. We conducted distal pancreatosplenectomy and resected the distal transverse colon and constructed a transverse colostomy. Pathologically, cancer of the pancreas was diagnosed as poorly differentiated adenocarcinoma. Its vascular invasion into the spleen resulted in splenic infarction. Pancreatic cancer also perforated the transverse colon, possibly causing secondary infection in addition to the splenic infarction. Such a case as ours is very rare and the underlying etiology is quite unique.

Key words
splenic abscess, pancreatic tail cancer, colonic invasion

Reprint requests
Kei Yonezawa Department of Surgery, Shizuoka City Shizuoka Hospital
10-93 Otemachi, Aoi-ku, Shizuoka, 420-8630 JAPAN

Accepted
November 19, 2008

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