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

Background. The prevalence, course, treatment, outcome and risk factors of splenic 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 followed up for a mean of 7.0 years were compared with patients without splenic complications. Results. Eleven men (2.2 per cent) with alcoholic chronic pancreatitis (median duration 2 (range 0-5) years) had a splenic complication: intrasplenic pseudocyst (n = 5), subcapsular haematoma (n = 2) or splenic rupture (n = 4). All patients except one underwent splenectomy, five of whom also underwent distal pancreatectomy. There were no deaths. Patients with splenic complications 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 splenic vein occlusion (seven of 11 versus 10.8 per cent; P < 0.0001) more frequently than those without. In the 2.2 patients with distal pseudocyst and splenic vein occlusion, the prevalence of splenic complications was 18 per cent (odds ratio 15.0 (95 per cent confidence interval 4.0-55.7). Conclusion. Splenic complications occur early in the course of chronic pancreatitis, are rare and are favoured by splenic vein occlusion.