Abstract
Objective To describe the management and prognosis of splenic abscess after splenic arterial embolization in severe acute pancreatitis (SAP) patients. Methods This is a retrospective observational study. From August 2012 to August 2017, SAP patients with infected pancreatic necrosis (IPN) who underwent splenic arterial embolization after massive hemorrhage of the splenic artery were screened and those who developed splenic abscess were included for analysis. The demographic characteristics, etiology, treatment of splenic abscess, and clinical outcomes of these cases were collected and analyzed. Results A total of 18 patients with splenic abscess formed after splenic arterial embolization were included for data analysis. The median age of the 18 patients was 46 years. The etiologies included biliary AP, hypertriglyceridemic AP (HTG-AP), and other causes. Ten patients underwent minimally invasive percutaneous drainage only for splenic abscess while the other eight patients received splenectomy. One patient died due to uncontrolled infection and another patient died due to massive bleeding, and the remaining sixteen patients survived. Conclusion The incidence of splenic abscess was high in patients requiring splenic arterial embolization due to massive bleeding. Our data showed that most splenic abscess could be successfully managed with minimally invasive interventions, and traditional splenectomy should serve as a backup treatment.
Highlights
Splenic arterial hemorrhage is one of the most serious and potentially lethal complications of severe acute pancreatitis (SAP), and the incidence of it is reported to be as high as 14.5% [1]
There were 571 cases of SAP patients complicated by infected pancreatic necrosis (IPN) admitted to Jinling Hospital screened from August 2012 to August 2017 in this study
There were 18 cases of splenic abscess formation after splenic arterial embolization included for analysis, among whom 10 cases were treated with percutaneous catheter drainage only and 8 cases required splenectomy
Summary
Splenic arterial hemorrhage is one of the most serious and potentially lethal complications of severe acute pancreatitis (SAP), and the incidence of it is reported to be as high as 14.5% [1]. Angiographic and vascular embolization has been proven to be a safe and effective treatment option for these patients [2,3,4]. When splenic arterial hemorrhage is controlled, with splenic arterial embolization, the probability of splenic infarction and/or splenic abscess formation increases significantly. Surgical procedures remain the standard treatment for splenic abscess, and percutaneous drainage for splenic abscess is only reported in cases. Studies regarding the diagnosis and treatment of splenic abscess caused by splenic arterial embolization in SAP patients are scarce in the literature. We retrospectively collected a series of SAP cases undergoing splenic arterial embolization after bleeding to show the clinical characteristics of these patients and currently available treatment options
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