NONSURGICAL TREATMENT OF PANCREATITIC PSE UDOCYSTS OF THE SPLEEN

Pancreatitic pseudocysts of the spleen are rare events. We report two cases of conservative management of splenic involvement in pancreatiti s by ultrasound-guided aspiration. The first patient was admitted with clinical and biochemical signs of acute exacerbation of chronic pancr eatitis. The ultrasound examination showed a subcapsular anechoic zone in the spleen as well as pancreatic pseudocysts. The laboratory exami nation of the fluid obtained by ultrasound-guided aspiration confirmed the presence of an intra-splenic pancreatitic pseudocyst which disapp eared completely after a second percutaneous aspiration. The second pa tient was admitted with acute exacerbation of chronic pancreatitis and septic symptoms caused by an abscess near the left lobe of the liver. After successful surgical drainage of the abscess the patient develop ed an expanding anechoic subcapsular fluid zone in the spleen. Quantit ative decompression by ultrasound guided fine needle-aspiration confir med the pancreatitic origin of the lesion which vanished within a few days without further treatment. We conclude that fine-needle aspiratio n of splenic pseudocysts under ultrasound control permits a differenti al diagnostic distinction from splenic abscess or hematoma and acceler ates healing. There is thus a nonsurgical option for treatment of panc reatitic intrasplenic pseudocysts, provided that the patient is under close clinical observation.