Gastroenterologia Japonica Copyright 9 1992 by The Japanese Sociefy of Gastroenterology VoL 27, No. 5 Printed in Japan Intrasplenic pancreatic pseudocyst: A case report Nobuhiko UEDA 1, Nobuki TAKAHASHI l, Hideo YAMASAKI l, Kazunori HIRANO 1, Kazuhiko UEDA 2, Shigeru YOSHIDA 3, Mikio TANINO 3, and Toshifumi GABATA4 Departments of 1Surgery and :Roentgenology, Kaga Central Hospital, Kaga, Japan; 3First Department of Pathology, Kanazawa Medical University, Kanazawa, Japan; and 4Department of Roentgenology, School of Medicine, Kanazawa University, Kanazawa, Japan Summary: An intrasplenic psudocyst associated with the acute relapsing phase of chronic pancreatitis in a 51-year-old woman is reported, with a review of the Japanese literature. The patient was admitted with a complaint of left lateral and back pain. Abdominal US and CT revealed communicating cysts at the pancre- atic tail and the subcapsule of the spleen. A repeat US and CT 1 month after admission demonstrated en- largement of the cyst at the pancreatic tail. ERCP revealed a dilated main pancreatic duct without any definite evidence of stenosis, and direct communication with the cyst at the pancreatic tail. Percutaneous cystography revealed that the subcapsular cyst of the spleen, the cyst of the pancreatic tail, and the main pancreatic duct communicated with each other. The cyst contained serous fluid with an amylase content of 57,500 IU/I. Distal pancreatectomy and splenectomy was performed. Histologically, there was a nonepithe- lial lining on the inner surface of the cysts at the pancreatic tail and the subcapsule of the spleen. Severe chronic inflammatory changes were present in the resected tail of the pancreas. Timely surgical treatment is advocated to reduce the mortality and morbidity associated with complications of intrasplenic pseudocysts. Gastroenterol Jpn 1992;27:675-682. Key words: chronic pancreatitis; intrasplenic pseudocyst; pancreatic pseudocyst. Introduction The late complications of acute pancreatitis or the acute relapsing phase of chronic pancreatitis are varied and are as important as the early complica- tions. The formation of a pseudocyst is one of the most common late complications. Typically, biolog- ically active pancreatic secretions dissect to form a pseudocyst in the lesser sac, with the cyst walls formed by the stomach, colon, and mesocolon. Cases of a pancreatic pseudocyst involving the spleen are extremely rare. The authors report one case ofintrasplenic pseudocyst associated with the acute relapsing phase of chronic alcoholic pan- creatitis, and review the Japanese literature. Case Report A 51-year-old woman was admitted to the Depart- ment of Surgery, Kaga Central Hospital on June 12, 1991, complaining of left lateral and back pain. She had been drinking 5 bottles of beer per day for 10 years. Prior to admission she had received medical treatment for acute pancreatitis twice at ages 46 and 47. Since then she had been free of symptoms. She had been suffering left lateral and back pain, abdominal fullness, and poor appetite beginning in March, 1991. On admission in June she was found to have elevated serum and urine amylase levels and a splenic cyst was found by an abdominal ultrasonography (US). Physical examination on admission revealed neither anemia nor icterus. The abdomen was soft Received December 17, 1991. Accepted April 17, 1992. Address for correspondence: Nobuhiko Ueda, M.D., Department of Surgery, Kaga Central Hospital,65 Hakkendou, Daishouji, Kaga 922, Japan.