Laparoscopic treatment of intrasplenic pancreatic pseudocyst

INTRODUCTION: Pseudocyst formation commonly follows pancreatitis, but erosioninto the spleen is rare and potentially life threatening. We report a case of an intrasplenic pancreatic pseudocyst treated laparoscopically with distalpancreatectomy and splenectomy.METHODS: A 50 year old male with a history of chronic alcoholic pancreatitis,presented with abdominal pain for 3 months, worsening over the past several days.A CT scan showed a broad 9 cm subcapsular fluid collection suspicious for anintra-splenic pseudocyst. The patient underwent laparoscopic distalpancreatectomy and splenectomy.RESULTS: There were no intraoperative complications and the patient wasdischarged on day 8. The final pathology revealed a benign cystic lesionmeasuring 9 x 6 x 3 cm that was not communicating with the pancreatic duct, and 2smaller pseudocysts in the pancreatic body and tail. A previous scan did notreveal any abnormalities in the spleen, and showed the other pancreaticpseudocysts. At 8 month follow up the patients was symptom free, with no newpseudocysts.CONCLUSIONS: Splenic parenchyma involvement is an unusual complication ofpancreatic pseudocyst. The optimal treatment is controversial. Percutaneousdrainage carries a high recurrence rate and risk of hemorrhage. Open surgery iseffective, but associated with significant morbidity. Laparoscopy offers aneffective method of treatment without the potential complication of a largeabdominal incision.