The spleen in inflammatory pancreatic disease

As the pancreas and the spleen lie in close proximity, splenic complications may occur in the course of acute or chronic pancreatitis in the form of isolated splenic vein thrombosis, intrasplenic pseudocysts, splenic rupture, infarction, and necroses as well as splenic hematoma and severe bleeding from eroded splenic vessels. Diagnosis is usually made under emergency conditions and is mainly based on ultrasound and computed tomography plus bolus injection and splenoportography. Additionally, ultrasound- or computed tomography-guided needle aspiration of fluid collection in the left upper quadrant may be helpful. Such conditions may be life threatening and, according to the increasing number of case reports, may be more frequent than is thought. They must be added to the list of other important extrapancreatitic complications such as shock and respiratory and renal failure. This review summarizes the present knowledge on splenic complications in acute and chronic pancreatitis for purposes of timely diagnosis and treatment and draws attention to the need for follow-up examinations of the spleen by imaging procedures in the course of acute and chronic pancreatitis.