Splenic complications in chronic pancreatitis: prevalence and risk factorsin a medical-surgical series of 500 patients

Background The prevalence, course, treatment, outcome and risk factors of s plenic complications in chronic pancreatitis are poorly documented. Methods Patients with splenic complications in a medical-surgical series of 500 consecutive patients with proven chronic pancreatitis prospectively fo llowed up for a mean of 7.0 years were compared with patients without splen ic complications. Results Eleven men (2.2 per cent) with alcoholic chronic pancreatitis (medi an duration 2 (range 0-5) years) had a splenic complication: intrasplenic p seudocyst (n = 5), subcapsular haematoma (n = 2) Or splenic rupture (n = 4) . All patients except one underwent splenectomy, five of whom also underwen t distal pancreatectomy. There were no deaths. Patients with splenic compli cations had pancreatic tail necrosis (six of 11 versus 17.4 per cent; P = 0 .007), distal pseudocyst (six of 11 versus 11.7 per cent; P = 0.0009) or sp lenic vein occlusion (seven of 11 versus 10.8 per cent; P<0.0001) more freq uently than those without. In the 22 patients with distal pseudocyst and sp lenic vein occlusion, the prevalence of splenic complications was 18 per ce nt (odds ratio 15.0 (95 per cent confidence interval 4.0-55.7). Conclusion Splenic complications occur early in the course of chronic pancr eatitis, are rare and are favoured by splenic vein occlusion and pseudocyst or necrosis of the pancreatic tail. Surgical treatment is usually required .