Splenic Subcapsular Hematoma Complicating a Case of Pancreatitis

Splenic subcapsular hematoma is a rare complication of pancreatitis. The splenic vessels and the pancreatic tail lie close together in the lienorenal ligament. The pathologies in the pancreatic tail may occasionally affect the spleen resulting in splenic vein thrombosis, arterial pseudoaneurysm, subcapsular splenic hematoma, and splenic rupture. A 40-year-old male with a history of alcohol abuse and alcohol-induced pancreatitis presented with severe epigastric abdominal pain and was diagnosed with pancreatitis. Later during hospitalization he became dyspneic and hemodynamically unstable, with acute anemia requiring blood transfusion. An abdominal CT with angiography (CTA) revealed a splenic subcapsular hematoma with active bleeding which was managed by urgent exploratory laparotomy and splenectomy. Due to its rarity, diagnosis of splenic hematoma in pancreatitis is challenging with rapid identification and intervention being key to management.