Houry S, Sellem G, Huguier M
Gastroenterol Clin Biol. 1985 Dec;9(12):918-21.
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.
除了与节段性门静脉高压相关的脾肿大外，慢性胰腺炎病程中观察到的脾脏并发症并不常见。这些并发症可能包括脾坏死、脾内假性囊肿和脾破裂。脾自发性破裂是最罕见的事件之一，迄今为止共报道了29例。我们在此报告4例新病例，并对先前记录的病例进行了回顾。在我们的病例中，脾破裂发生在年轻男性患者中。该并发症在1例中揭示了胰腺疾病，而在其他病例中，平均发生在胰腺疾病症状出现后7个月。这表明该并发症发生在慢性胰腺炎自然病程的早期。脾脏病变的机制仍不清楚，文中讨论了不同的病因，包括机械性、酶性或血管性。我们的患者均无轻微外伤，强调了破裂的自发性。除1例病例外，诊断均通过手术发现，在该例中，选择性动脉造影对术前确诊最有帮助。2例患者接受了单纯脾切除术治疗，另外2例患者同时进行了远端胰腺切除术。恢复过程顺利。同时对1例伴有胰腺假性囊肿进行了治疗。
