Subcapsular Hematoma of the Spleen in acute sever pancreatitis unusual complication

controlled with medication presented to emergency department with complain of one week abdominal pain, vomiting and anorexia. Two weeks prior to her presentation she was hospitalize in periphery hospital with diagnosis of pancreatitis. She was managed conservatively at surgical ward and discharge in stable condition. She was planned for interval cholecystectomy. At her presentation she wasn’t able to take orally with frequent vomiting. She had abdominal pain mainly at epigastric area intermittent with radiation to the back. She had no fever, jaundice, nor change of bowel habit. She had no history of trauma or previous interventions. There was no history of use of anticoagulation. She had no previous surgery. Other systemic review was unremarkable. Clinical examination showed elderly women comfortable in bed not in distress. Her vital sign was stable. The abdominal examination showed mild tenderness at epigastric area. She had leuckocytosis of 17, hemoglobin of 96. Liver function test was normal except mild indirect hyper bilirubinemia which was normalizing in follow up labs her amylase was normal. Abdominal ultrasound showed thick gallbladder wall with gallstone. There was no dilatation of common bile duct or intra hepatic ducts. CT abdomens showed sign of sever necrotizing pancreatitis with multiple pancreatic tail pseudocyst [Figure1]. She was diagnosed with complicated sever necrotizing pancreatitis. She was managed conservatively. Follow up C.T in 2 weeks period done for her persistent symptoms which showed large sub-capsular hematoma of spleen. The size was 13 *6 * 10 cm [Figure2]. Ultrasound guided drainage done for the hematoma. Post drainage patient was kept in monitor bed till output was serous in color follow up C.T showed complete resolution. During laparoscopic cholecystectomy, there was an intra-operative finding of adhesion and cholecystentric fistula [Figure3]. The fistula was taken down and repaired with intracorporal PDS suture after removal of the stone [Figure 4, 5]. Post operatively was uneventful follow up C.T after a month from discharge showed no recurrence [Figure 6].