Intrahepatic and Intrasplenic Pancreatic Pseudocysts Following Acute Pancreatitis: A Case Report.

Pancreatic pseudocysts are common local complications of acute pancreatitis; however, intrahepatic and intrasplenic localization is exceptionally rare. The simultaneous occurrence of pancreatic pseudocysts in both the liver and spleen has been described in only a limited number of cases. We present the case of a 64-year-old man with alcohol-related pancreatitis who developed multiple pancreatic pseudocysts involving the liver, spleen, left subphrenic space, lesser omentum, and falciform ligament. Contrast-enhanced computed tomography demonstrated large intrahepatic pseudocysts in segments II and III of the liver and a large intrasplenic pseudocyst. The patient was initially managed conservatively, followed by percutaneous drainage of the intrahepatic and left subphrenic pseudocysts. Due to the high risk of hemorrhage, the intrasplenic pseudocyst was not treated by percutaneous drainage. Progressive enlargement of the splenic pseudocyst necessitated open surgical drainage. The postoperative course was complicated by a pancreatic fistula, which resolved with conservative management within two months. This case highlights the rarity of simultaneous intrahepatic and intrasplenic pancreatic pseudocysts and demonstrates that management should be individualized according to the location of the pseudocysts and the associated procedural risks. Percutaneous drainage may be effective for intrahepatic collections, whereas surgical intervention remains an important treatment option for selected splenic pseudocysts.