[Spontaneous rupture of the spleen in chronic pancreatitis]

Excepting splenomegaly related to segmental portal hypertension, splenic complications observed during the course of chronic pancreatitis are uncommon. These may include splenic necrosis, intrasplenic pseudocysts and splenic rupture. Spontaneous rupture of the spleen is one of the least common events, a total of 29 cases being reported thus far. We present herein 4 new cases, and previously documented cases were reviewed. In our cases, the splenic rupture occurred in young male patients. This complication revealed the pancreatic disease in one case while in the others, it occurred on the average 7 months after the symptomatic onset of pancreatic disease. This suggests that this complication occurs early in the natural history of chronic pancreatitis. The mechanism of the splenic lesion remains unclear, the different causes advanced, mechanic, enzymatic or vascular, are discussed. None of our patients had minimal trauma emphasizing the spontaneous character of rupture. Diagnosis was a surgical discovery except in one case in which selective arteriography was of most valuable aid in confirming diagnosis preoperatively. Treatment was simple splenectomy in 2 cases and associated with distal pancreatectomy in the 2 other cases. Recovery was uneventful. A corporal pancreatic pseudocyst was treated at the same time.