Hämorrhagische Milzläsionen bei chronischer und chronisch-rezidivierender Pankreatitis

Rupture of the spleen occurred in five patients (aged 44-59 years) in the course of chronic or chronic recurrent pancreatitis. In three patients the rupture was a consequence of perisplenic adhesions associated with subclinical chronic pancreatitis, in another there was direct enzymatic erosion of the splenic capsule via the phrenicosplenic ligament, and in the fifth patient haemorrhagic infarction followed splenic venous thrombosis. In four patient there was a history of chronic pancreatitis related to alcohol abuse. On admission all patients complained of breathing-related pains radiating into the shoulder. Three patients also had abnormal radiological signs in the left lower lung field (high diaphragm, effusion, infiltration). The findings can be explained pathogenetically by infiltration of the phrenicosplenic ligament which connects the tail of the pancreas with the splenic hilus and the diaphragm. The final diagnostic confirmation and indication for surgery was in all cases made by computed tomography. This is thus the imaging procedure of choice if splenic involvement is suspected in the course of chronic pancreatitis.