Laparoscopic Partial Splenectomy Research Articles

Comparison of perioperative outcomes between laparoscopic and open partial splenectomy in children and adolescents.

BACKGROUNDIn order to avoid consequences of total splenectomy, partial splenectomy (PS) is increasingly reported. The purpose of this study was to compare perioperative outcomes of laparoscopic PS (LPS) and open PS (OPS) in children and adolescents.AIMTo compare perioperative outcomes of patients with LPS and OPS.METHODSAfter institutional review board approval, a total of 26 patients that underwent LPS or OPS between January 2008 and July 2018 were identified from the database of our tertiary referral center. In total, 10 patients had LPS, and 16 patients underwent OPS. Blood loss was calculated by Mercuriali’s formula. Pain scores, analgesic requirements and complications were assessed. The Wilcoxon rank sum test was used for comparison. To compare categorical variables, Fisher’s exact test was applied.RESULTSLPS was performed in 10 patients; 16 patients had OPS. Demographics (except for body mass index and duration of follow-up), indicating primary disease, preoperative spleen size and postoperative spleen volume, perioperative hematological parameters, postoperative pain scores, analgesic requirements, adverse events according to the Clavien-Dindo classification and the comprehensive complication index, median time from operation to initiation of feeds, median time from operation to full feeds, median time from operation to mobilization and median length of hospital stay did not differ between LPS and OPS. Median (range) operative time (min) was longer in LPS compared to the OPS group [185 (135-298) vs 144 (112-270), respectively; P = 0.048]. Calculated perioperative blood loss (mL of red blood cell count) was higher in the LPS group compared to OPS [87 (-45-777) vs -37 (-114-553), respectively; P = 0.039].CONCLUSIONThis is the first study that compared outcomes of LPS and OPS. Both operative approaches had comparable perioperative outcomes. LPS appears to be a viable alternative to OPS.

Splenectomy

Laparoscopic splenectomy has become an established standard of care in the management of surgical diseases of the spleen, except in the hemodynamically unstable trauma patient requiring splenectomy. Although adoption of minimally invasive splenectomy has led to a gradual decrease in the indications for open splenectomy, both procedures are still essential components of spleen surgery. This review describes the indications and contraindications for procedure, preoperative preparation and consent, operative anatomy and technique, and long-term follow-up. Tables review the clinical indications for splenectomy, classification of splenectomy, a comparison of laparoscopic versus open postsplenectomy outcomes, indications and contraindications for partial splenectomy, and reported incidences of postoperative outcomes and complications after splenectomy. Figures depict splenomegaly, the American Society of Hematology 2011 evidence-based practice guidelines for management of primary idiopathic thrombocytopenic purpura in children and adults, a splenic mass, a splenic cyst, massive splenomegaly, laparoscopic splenectomy, the 2014 Centers for Disease Control and Prevention recommendations for adult and pediatric splenectomy vaccination, splenic artery embolization, various laparoscopic approaches to splenectomy, splenic vascularization, division of splenic artery branches, suspensory ligaments of the spleen, laparoscopic exposure and transection of splenic hilum, retrieval bags and related procedures, open splenectomy, stapling, and laparoscopic partial splenectomy. Videos demonstrate purely laparoscopic splenectomy and hand-assisted laparoscopic splenectomy. This review contains 26 figures, 5 tables, 2 videos, and 111 references.

Laparoscopic Partial Splenectomy: A Critical Appraisal of an Emerging Technique. A Review of the First 457 Published Cases.

Background: Laparoscopic partial splenectomy (LPS) may allow avoiding total splenectomy (TS) complications and maximizing the advantages of mini-invasive approach. The objective of this review is to assess feasibility and safety of LPS, to compare this approach with alternative options. Materials and Methods: A literature review of articles reporting LPS is performed. Several parameters, including age, indication, surgical technique, devices used for splenic section/hemostasis, adverse outcomes, including morbidity/mortality, conversions to open surgery, conversions to TS, operative time (OT), and hospital stay (HS), are analyzed. Articles comparing LPS' results with those of open partial splenectomy and laparoscopic TS are also analyzed. Results: Fifty-nine articles reporting 457 LPS were included. Patients' characteristics varied widely, concerning age and indications, including hematological disease (hereditary spherocytosis, drepanocytosis), splenic focal masses, and trauma. Several technical options are reported. Mean OT and HS are 128 ± 43.7 minutes and 4.9 ± 3.8 days, respectively. No mortality and 5.7% morbidity are reported. Conversion rates to open surgery and to TS are 3.9% and 3.7%, respectively. Conclusions: In conclusion LPS is feasible and safe, with no mortality, low morbidity, and low conversion rates to laparotomy and to TS. LPS may be accomplished by various techniques and tools. Major complications are sporadically reported, thus potential risks should not be underestimated.

Laparoscopic Partial Splenectomy with Distal Pancreatectomy Preserves Splenic Function

Introduction: Distal Pancreatectomy often requires splenectomy, for oncologic reasons, or because splenic vessels are involved. The immune function of the spleen is increasingly recognized, and many national guidelines suggest long term antibiotics following splenectomy.

Laparoscopic partial splenectomy for a splenic hamartoma

We discuss current knowledge and management of splenic hamartoma, an uncommon form of benign tumor. A splenic hamartoma is a rare form of benign splenic mass, often found incidentally while working up other complaints, and is typically treated by surgical resection of the mass. In this case, we discuss the management of an incidentally found splenic hamartoma that was treated with laparoscopic partial splenectomy. The patient presented in the Emergency Department complaining of periumbilical pain after having been struck in the abdomen with a soccer ball the previous day. Following a physical exam and blood work, an ultrasound was performed that revealed a hypoechoic area within the spleen. The patient received a diagnosis of gastroenteritis and an appointment for follow-up at 2 months. At 2-month follow-up, an ultrasound indicated that the mass had grown. The mass appeared consistent with a splenic hemangioma, so the patient was scheduled for laparoscopic partial splenectomy. The mass was completely resected without any complications. The patient had an uncomplicated postoperative course. When there are no other indications for a total splenectomy and malignancy is unlikely, laparoscopic partial splenectomy appears to be a reasonable treatment modality for a splenic hamartoma.

Laparoscopic Central Splenectomy for Littoral Cell Angioma

BackgroundSplenic littoral cell angioma (LCA) is a rare vascular tumor with malignant potential originating from the red pulp of the spleen.1,2 Although laparoscopic splenectomy is the treatment choice for LCA,3 patients suffer from long-term complications of sepsis, thrombosis, and tumor.4,5 Laparoscopic central splenectomy (LCS) for LCA is a technically challenging operation mainly due to the risk of intraoperative hemorrhage. However, it can be a valuable alternative particularly for adolescent patients in whom maximum preservation of splenic function outweighs the risks associated with organ preservation. MethodsA 15-year-old young man was admitted with left upper abdominal dull pain for 1 month. Laboratory tests and enhanced abdominal CT scans were performed. Laboratory test results were all normal, as follows: complete blood count showed normal WBC: 5.74 × 109/l, platelets: 173 × 109/l, Hb: 151 g/l, tumor markers (CEA: 1.62 ng/ml, CA19–9: 10.30 U/ml, AFP: 1.13 ng/ml) which were within normal limits. CT scan showed that a 5 × 5.9-cm solid tumor was discovered in the middle part of the spleen during diagnosis, and the density of this tumor was high in the early artery phase and low in the late portal venous phase of contrast-enhanced CT. LCS was performed where the trunk of the splenic artery was intermittently occluded and several branches of the vessels were freed from the tumor which was then resected. The splenic parenchyma was dissected by following a line 0.5 cm from demarcation line. The tumor was completely removed with the activity of the splenic parenchyma being preserved to the maximum extent. Total operation time was 175 min, with an estimated blood loss of 200 ml; thus, no blood transfusion was required. Intraoperative frozen section suggested vascular tumor-like lesions, and then the tumor was completely removed with the resection margin being free of tumor involvement. ResultsThe patient was fully recovered after a 7-day hospital stay. The reason for the 7-day hospital stay is that the patient maintains normal ambulating independent assistance on POD-3 and can eat without intravenous fluids on POD-4. Meanwhile, the patient needs to remove the drainage tube after the abdominal CT scan on POD-6, rather than postoperative complications. Diagnosis of LCA was confirmed using histology, and the symptoms disappearing after the operation was done. A total of 86·laparoscopic partial splenectomy (LPS) procedures were performed at the Department of Pancreatic Surgery, West China Hospital and Department of Hepatopancreatobiliary Minimal Invasive Surgery, Chengdu ShangJin NanFu Hospital from May 2011 to May 2020. Five patients among the total number of patients were diagnosed with LCA of which LPS was performed in four patients and LCS performed for one patient. The mean duration of surgery for LPS was 100 min (range of 80-120 min) while the mean estimated blood loss was 125 ml (range of 100-200 ml). On the other hand, the mean length of hospital stay was 7.5 days (range of 5-11 days) and the mean tumor diameter was 5.1 cm (range of 3.2-7 cm). All patients recovered without complications. In addition, there were no signs of immune insufficiency, thrombosis, and tumor recurrence during the follow-up which had a mean of 31.2 months (range from 10 to 53 months). ConclusionLCS is a technically feasible technique for a select group of patients with centrally located LCA. The technique helps to maximize preservation of splenic function and maintains the advantages of minimally invasive surgery.

Laparoscopic partial splenectomy for splenic lymphangioma: a case report

BackgroundLymphangioma is a benign malformation of the lymphatic system and is often found in the neck and axilla, the orbit, the mediastinum, etc. However, isolated splenic lymphangioma is a rare disease in young women, and its treatment is controversial. We report a case of laparoscopic partial splenectomy for isolated splenic lymphangioma in a young woman.Case presentationAn 18-year-old woman with mild epigastralgia was admitted to a nearby hospital. Abdominal ultrasound detected a 6-cm mass confined to the upper pole of the spleen; thereafter, she was referred to our department for surgical treatment. Although a benign tumor, we decided to resect it because of her symptoms. To preserve part of the normal spleen, laparoscopic partial splenectomy was performed with a co-axial approach using four ports and a liver retractor in the lithotomy position. After dissection around the spleen hilum, we identified that the tumor was being fed from the splenic vessels of the upper pole and severed the branch. Postoperatively, the patient showed no complications and was discharged on postoperative day 8 without symptoms. Pathological examination revealed splenic lymphangioma, which is rare in young women. No recurrence was seen 1 year after surgery, and a computed tomography scan showed no problems with the remaining spleen.ConclusionsIn our experience of laparoscopic partial splenectomy for a young woman with an isolated splenic lymphangioma, we determined that laparoscopic partial splenectomy is a safe, effective, and valuable option for the treatment of benign splenic tumors.

Challenge in differentiation of pancreatic cystic neoplasms between intraductal papillary mucinous neoplasm and mucinous cystic neoplasm: A case report

AbstractIncidental pancreatic cystic neoplasms (PCNs) are frequently detected as a result of advances in imaging technologies nowadays. Cystic lesions with higher malignant potential include mucinous neoplasms, such as intraductal papillary mucinous neoplasm (IPMN) and mucinous cystic neoplasm (MCN). There are crucial differences between MCN and IPMN in their biological behavior and clinical prognosis. However, currently available tools are imperfect to differentiate between IPMN and MCN. We reported a case of a 46‐year‐old woman with incidental pancreatic tail cyst of 8 cm size. Computed tomography scan and endoscopic ultrasound with fine‐needle aspiration showed a tumor located at the pancreatic tail. The macrocystic lesion had septa and peripheral calcification, and cystic fluid analysis revealed high level of carcinoembryonic antigen (CEA) with low level of amylase. These clinical features are suggestive of MCN in previous experience. Patient underwent laparoscopic distal partial pancreatectomy and splenectomy. The final pathological result was IPMN. Following the application of updated 2017 consensus guideline and 2018 American College of Gastroenterology (ACG) guideline will provide more precise preoperative evaluation and postoperative surveillance. We try to explain the discrepancy between the diagnostic modalities, and more cost‐effective, validated biomarkers are required for differentiating PCNs in the future.

Treatment options for sclerosing angiomatoid nodular transformation of spleen

BackgroundTo summarise the clinical features of Sclerosing angiomatoid nodular transformation (SANT) of the spleen and to compare the efficacy of three different surgical treatments. MethodsWe performed a retrospective analysis of patients with SANT of spleen treated at our center from 2009 to 2018. We compared the efficacy and safety of three different types of surgical procedures. ANOVA and the chi-square test were used for statistical analysis. ResultsA total of 37 patients were included. Most (35/37; 94.6%) were asymptomatic. A number presented as obscure boundary lesions such that malignancy could not be excluded. Open splenectomy was performed for 12 patients, laparoscopic splenectomy for 12 patients and laparoscopic partial splenectomy for 13 patients. Operation time (P = 0.355), blood loss (P = 0.135), length of hospital stay after operation (P = 0.271) and postoperative complications (P = 0.502) were comparable between the three groups. Duration of drainage tube placement was significantly longer in laparoscopic partial splenectomy patients (P = 0.006). Peak platelet count after operation was significantly lower in laparoscopic partial splenectomy patients (P < 0.001). ConclusionLaparoscopic partial splenectomy appears to be a technically feasible and therapeutically effective approach for SANT.

Laparoscopic partial splenectomy with temporary occlusion of the trunk of the splenic artery in fifty-one cases: experience at a single center.

Laparoscopic partial splenectomy (LPS) for splenic benign space-occupying lesions has been reported by many researchers; however, few studies have described methods to control intraoperative bleeding. Trustworthy experience in LPS with a satisfactory intraoperative hemorrhage control technique is therefore necessary. The current study aims to present our experience in LPS with temporary occlusion of the trunk of the splenic artery for controlling intraoperative bleeding with a large sample of 51 cases and to evaluate the safety, feasibility, and reproducibility of this technique. Fifty-one patients from August 2014 to April 2019 who underwent LPS in our institution were retrospectively analyzed. Surgical techniques were described in detail. All patients had successfully undergone LPS with temporary occlusion of the trunk of the splenic artery. Conversions to open surgery, hand-assisted laparoscopic splenectomies, or blood transfusions were not needed. The operative time was 94.75 ± 18.91min, the estimated blood loss was 71.13 ± 53.87ml, and the volume of resected spleen was 34.75 ± 12.19%. The range of postoperative stays was 4-14days. One female patient (2%, 1/51) suffered from postoperative complications. No perioperative mortality, incision infections, postoperative pancreatic fistulas (POPFs), splenic infarctions, or portal/splenic vein thromboembolic events occurred. LPS is an effective spleen-preserving surgery. Although there are many other bleeding control methods, temporarily occluding the trunk of the splenic artery was found to be a safe, feasible, and reproducible technique in LPS. The outcomes of this technique and the efficacy of splenic parenchyma preservation are acceptable.

915 MHz microwave-assisted laparoscopic partial splenectomy: A case series.

Background:Haemorrhage during the splenic parenchyma transection is a major threat for laparoscopic partial splenectomy (LPS). We here aim to evaluate the feasibility and safety of pre-coagulation of a 915 MHz microwave (MW) device during LPS.Materials and Methods:Data of four patients admitted to our hospital between November 2016 and July 2018 were retrospectively analysed. The mean age was 24 years (range, 19–33); they all diagnosed with splenic unifocal lesion with a mean diameter of 4.6 cm (ranged from 3.7 to 6 cm) and underwent LPS with pre-coagulation of a 915 MHz MW.Results:The LPS with pre-coagulation was successfully resulted in complete resection without microscopic residual tumour (R0 resection). The mean operative time was 205 min, and the minimum blood loss was at the range of 30–50 ml. No complication was observed, and the length of stay in hospital was varied from 5 to 10 days.Conclusion:Based on our observation, pre-coagulation of a 915 MHz MW during LPS is a safe and efficient technique. More studies are required before applying extensively.

Laparoscopic partial splenectomy of benign tumors assisted by microwave ablation.

The aim of this study is to investigate the application and the feasibility of microwave ablation in laparoscopic partial splenectomy. From January 2018 to June 2019, four patients with benign spleen lesions in our hospital underwent laparoscopic partial splenectomy assisted by microwave ablation. The reviewed parameters included the operation time, intraoperative blood loss, ablation time, frequency of ablation, postoperative drainage time, postoperative hospitalization time, and postoperative complications. All four patients underwent laparoscopic partial splenectomy assisted by microwave ablation successfully, and there were no cases of conversion to laparotomy. The operation time was 100-200 min (mean, 152.5 min) and ablation time was 16-35 min (mean, 22.8 min). The frequency of ablation was 4-7 times (mean, 5.3 times), and the intraoperative blood loss was 5-300 ml (mean, 138.8 ml). The postoperative drainage time was 3-5 d (mean, 3.3 d), and postoperative hospital stay was 3-9 d (mean, 7.8 d). There were no complications such as peripheral tissue injury, massive bleeding, infestation of spleen fossa, and pancreatic leakage. Microwave ablation is worthy of clinical application in laparoscopic partial spleen resection as it is safe and effective with low rates of bleeding and fast recovery.

A Huge Splenic Cyst: Case Report

Splenic cyst is a relatively rare disease. They may occur secondary to trauma or even being more seldom due to parasitic infections, mainly caused by ecchinococcus granulosus. This patient had an atypical symptomatology, consisted mainly of fullness in the left upper abdomen and a palpable mass. Preoperative diagnosis was established with ultrasonography and computerized tomography. lmmunohistochemistry allows differential diagnosis between epidermoid and mesothelial cyst. For many years, open splectomy was the accepted treatment. Laparoscopic partial splenectomy is a procedure for the treatment of splenic cysts, because it cures the disease preserving the splenic tissue. Complete splenectomy is reserved for cases in which cyst excision cannot be done otherwise.&#x0D; Journal of Surgical Sciences (2012) Vol. 16 (2) : 101-105

Laparoscopic Partial Splenectomy in Pediatric Age Group: Cairo University Experience

Abstract Introduction: Laparoscopic partial splenectomy (LPS) theoretically preserves long-term immune functions of the spleen. This video presentation aimed at testing the feasibility of LPS in av...

Acute Chest Syndrome After Splenectomy in Children With Sickle Cell Disease

BackgroundIndividuals with sickle cell disease (SCD) are at high risk of developing life-threatening complications, particularly acute chest syndrome (ACS) postoperatively. The perioperative factors associated with the development of ACS in children with SCD after splenectomy have not been clearly identified. Materials and methodsWe retrospectively reviewed medical records of all children who underwent splenectomy at our institution between 1997 and 2017 with the goal of identifying perioperative factors associated with postoperative ACS. Categorical and noncategorical variables were compared using Fisher’s exact test and Student's two-tailed t-test, respectively. ResultsSixty-five patients with SCD underwent splenectomy at a median of 4.0 (interquartile range [IQR] 2.0-8.0) years of age. A laparoscopic approach was used for 64 (98.5%) patients. Fifty-six (86.2%) underwent laparoscopic total splenectomy, and eight (12.3%) underwent laparoscopic partial splenectomy, of which two were converted to open. One had an open partial splenectomy (1.5%). Of the 65 patients, 10 (15.4%) developed ACS with a mean time to diagnosis of 49.0 ± 34.5 h. Children who developed ACS had a higher postoperative median pain score of 6.8 (IQR 5.1-9.1) versus 2.7 (IQR 1.6-4.2), P < 0.001, higher median pain score area under the curve 111.5 (IQR 76.9-169.1) versus 47.3 (IQR 30.5-78.3), P = 0.01, and received more total morphine equivalents (median 1.4 [IQR 0.4-2.7] versus 0.5 [IQR 0.3-0.9] mg/kg, respectively; P = 0.003), compared with children who did not develop ACS. ConclusionsSignificant postoperative pain may be an early sign of ACS that could be worsened by opioid use, supporting the investigation of nonopioid pain control options in this patient population.

Feasibility and Safety of Laparoscopic Partial Splenectomy: A Systematic Review.

Laparoscopic partial splenectomy (LPS) is a challenging procedure. The aim of this review was to evaluate its feasibility, safety, and potential benefits. We conducted a comprehensive review for the years 1995-2018 to retrieve all relevant articles. A total of 44 studies with 252 patients undergoing LPS were reviewed. Six studies described combined operations. Ranges of operative time and estimated blood loss were 50-225min and 0-1200ml, respectively. There are eight patients need blood transfusion in 231 patients with available data. The conversion rate was 3.6% (9/252). Overall, 27 patients (10.7%;27/252) developed postoperative or intraoperative complications. Overall mortality was 0% (0/252). The length of postoperative stay (POS) varied (1-11days). Among four comparative studies, one showed LPS could reduce POS than laparoscopic total splenectomy (LTS) (LTS 5.4 ± 1.8days, LPS 4.2 ± 0.8days, p = 0.027) and complications (pleural effusion (LTS 9/22, LPS 0/15, p = 0.005), splenic vein thrombosis (LTS 10/22, LPS 0/15, p = 0.002)). Another comparative study showed LPS may benefit emergency patients. However, one comparative study showed LPS was associated with more pain, longer time to oral intake, and longer POS in children with hereditary spherocytosis. The fourth comparative study showed robotic subtotal splenectomy was comparable to laparoscopy in terms of POS and complication. The main benefits were lower blood loss, vascular dissection time, and a better evaluation of splenic remnant volume. In early series of highly selected patients, LPS appears to be feasible and safe when performed by experienced laparoscopic surgeons.

Totally Laparoscopic Partial Splenectomy in a Child with Hamartoma

Abstract Background: To date laparoscopic surgery plays a key role in the surgical treatment of not only splenic hematologic pathologies but also of solid pathologies such as benign and malignant t...

Laparoscopic Partial Splenectomy: A Safe and Feasible Treatment for Splenic Benign Lesions

The purpose of this study was to explore the safety and feasibility of laparoscopic partial splenectomy in treating splenic benign lesions (SBL). A total of 16 SBL patients clearly diagnosed before surgery (8 cases of splenic cysts, 5 cases of splenic lymphangioma, and 3 cases of splenic hemangioma) underwent 2D or 3D laparoscopic partial splenectomy from October 2013 to August 2016. The diameters of the SBL were 5 to 17 cm with an average of 8.7 cm; 12 cases were located in the upper pole of the spleen, and 4 cases were located in the lower pole of the spleen. All 16 patients successfully completed laparoscopic partial splenectomy, and no patients required conversion to an open operation. There were 3 cases of resection using the 3D laparoscope. There were 14 cases of resection of half of the spleen and 2 cases of partial resection of the lower spleen. The operation time was 110 to 195 minutes with an average time of 157 minutes. The amount of intraoperative blood loss was 80 to 200 mL, and no patients required blood transfusion. The postoperative abdominal drainage time was 3 to 5 days, and no abdominal bleeding, pancreatic leakage, subphrenic infection, or other complications occurred; the postoperative hospital stay lasted 5 to 6 days. Laparoscopic partial splenectomy is safe and feasible for the treatment of splenic benign lesions.

The effect of laparoscopic partial splenectomy for spleen benign lesions

Introduction: To confirm the value of laparoscopic partial splenectomy (LPS) in the surgical therapy of spleen benign lesions. Methods: A total of 22 patents with splenic benign lesions undergone laparoscopic splenectomy in Zhejiang University Huzhou Hospital from Sep 1 2016 to Aug 31 2017 were analyzed retrospectily. Results: Depending on the result of the preoperative imaging evaluation of the lesion's location and the future splenic volume, 7 patients were undergone laparoscopic total splenectomy (LTS) and 15 patients undergone LPS successfully without conversion to open splenectomy or LTS respectively . There is no statistic difference in operating time, intra-operative blood loss and transfusion between the two groups. However, the morbidity of LPS group was significant lower (p = 0.0012), and no thrombocytosis occurred in LPS patients. Additionally, the patients received LPS recovered quickly and the postoperative hospital stay was significant shorter (5.7 ± 2.3 vs. 15.3 ± 3.4 days, p = 0.0001) with a lower medical expenditure (19288 ± 2760 vs. 27737 ± 4626 ¥, p = 0.0013). No thrombocytosis and recurrence were observed during follow up in all 22 patients. Conclusions: According with the idea of enhanced recovery after surgery (ERAS) , LPS is safe and effective surgical therapy to preserve the function of spleen for selected patient with spleen benign lesions. Keywords: Laparoscope, partial splenectomy, spleen benign lesion, spleen preservation, postoperative outcome

The endoscopic ultrasound diagnosis of pancreatic ductal adenocarcinoma with cystic degeneration

Here, we present the case of an 87‐year‐old man who had dull upper abdominal pain for a month. Abdominal ultrasound and magnetic resonance imaging (MRI) demonstrated a cystic tumor in the pancreatic tail. Endoscopic ultrasound (EUS) showed a solid tumor with cystic degeneration, and fine‐needle aspiration (FNA) confirmed it was a pancreatic adenocarcinoma with tumor hemorrhage. The patient underwent a laparoscopic distal partial pancreatectomy and splenectomy. In this report, we emphasize that tumor hemorrhage‐related cystic degeneration is an uncommon manifestation of pancreatic ductal adenocarcinoma, and EUS with FNA may be more suitable for differential diagnosis than computed tomography or MRI.