Atraumatic splenic rupture is a rare but potentially life-threatening complication of pancreatic disease. This report describes the case of a 62-year-old man with a prior history of chronic pancreatitis related to alcoholic pancreatitis who presented with left upper abdominal pain without any history of trauma. Contrast-enhanced computed tomography demonstrated splenomegaly, a large splenic laceration, and a perisplenic hematoma without active contrast extravasation, along with a pancreatic cystic lesion and narrowing of the splenic vein. Magnetic resonance imaging showed heterogeneous signal intensity within the spleen, and a neoplastic lesion could not be excluded. On admission, serum amylase was mildly elevated at 149 U/L, HbA1c was 4.8%, and formal pancreatic exocrine function testing had not been performed before surgery. Because he was hemodynamically stable, conservative management was initially selected. However, persistent diagnostic uncertainty and concern for re-bleeding led to surgery on hospital day 9. Distal pancreatectomy with splenectomy and partial diaphragmatic resection was performed. Intraoperatively, the pancreas was indurated, consistent with chronic inflammatory change. Histopathological examination of the resected distal pancreas demonstrated chronic pancreatitis with fibrosis, mild chronic inflammatory cell infiltration, fat necrosis, pseudolobular formation, and focal acute inflammation, with no evidence of malignancy. The final diagnosis was atraumatic splenic rupture secondary to splenic vein thrombosis associated with chronic pancreatitis. This case highlights the need to consider splenic complications in patients with chronic pancreatitis who present with left upper quadrant pain and supports surgical management when malignancy cannot be excluded or when the risk of re-bleeding remains a concern.
Ryoichi Takenaka (2026) studied this question.