title: Occult splenic rupture in a case of chronic calcific pancreatitis with a brief review of literature.
abstract: BACKGROUND
  Splenic rupture in chronic pancreatitis is a life threatening rare complication. The anatomical proximity of the pancreas with the spleen and the pathophysiological process in acute and chronic pancreatitis form the basis of this dreaded complication.
  
  
  METHODS
  We cite the case of a young male previously undiagnosed with chronic pancreatitis presenting with atraumatic splenic rupture. Definitive diagnosis was made by contrast enhanced computed tomography of the abdomen, intra operative findings, and histopathological examination of the splenectomy specimen.
  
  
  CONCLUSIONS
  The splenorenal ligament forms the main anatomic proximity between the pancreas and the spleen. A few pathophysiological mechanisms though suggested are incompletely understood. splenic vein thrombosis, intrasplenic pseudocysts, splenic rupture, infarction, necrosis, splenic hematoma, and severe bleeding from eroded splenic vessels are the complications noted of which splenic rupture is the second most common following splenic vein thrombosis forming 36% of the complications noted. Chronic pancreatitis as an etiology of occult splenic rupture is rare and forms 8.27% of cases; commonest causes being neoplastic and infectious. The diagnosis is based on clinical and radiological findings and the management is predominantly surgical.
  
  
  CONCLUSIONS
  High clinical suspicion on the part of the treating physician and the emergency team is essential to the management of atraumatic splenic rupture. The increasing understanding of the pathophysiology and presentation of splenic complications in pancreatitis may alert the index physician to these fatal complications.
authors.affiliation: Department of General Surgery, St John's Medical College Hospital, Bangalore, India. Electronic address: 17.sharada@gmail.com.
authors.forename: Sharada
authors.initials: S
authors.lastname: S
authors.affiliation: Department of General Surgery, St John's Medical College Hospital, Bangalore, India.
authors.forename: S
authors.initials: S
authors.lastname: Olakkengil
authors.affiliation: Department of General Surgery, St John's Medical College Hospital, Bangalore, India.
authors.forename: A P
authors.initials: AP
authors.lastname: Rozario
keywords: Atraumatic; Chronic pancreatitis; Rupture; Spleen