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Pancreatitis in combination with splenic and vascular complications is dangerous and potentially lethal. The most common complications are intestinal or intraperitoneal hemorrhage resulting directly from either vascular changes, such as erosion of the splenic artery, formation of a pseudoaneurysm, hemorrhage into a pseudocyst, or rupture of a pseudocyst with perforation into the colon, or complications in the spleen, such as anemic or hemorrhagic infarction, abscess or rupture. CT is the method of choice for the diagnosis of splenic complications of pancreatitis. Angiography is indicated in every severe hemorrhage in the presence of pancreatitis, to demonstrate vascular changes and to localize the source of hemorrhage. In addition, acute arterial bleeding can be successfully treated with catheter embolization.

Over a 10-year period, nine patients (four men, five women, mean age 27 years) underwent surgery for splenic cysts (six epidermoid cysts, two mesothelial cysts and one pseudocyst). Six patients had had suggestive clinical symptoms, but, in the other three, the cysts were only discovered by chance on ultrasound scan. Three of the patients with epidermoid cysts had raised serum concentrations of the tumour markers carcinoembryonic antigen (CEA) or carbohydrate antigen (CA 19-9. All six benign epidermoid cysts contained immunohistochemically demonstrable CEA and/or CA 19-9 in the inner epithelial layer, implying a mesothelial origin for these cysts. In five cases the splenic cysts were completely extirpated (splenectomy in two, hemisplenectomy in one, enucleation in two); in four cases cyst resection was performed, leaving part of the cyst adherent to the spleen. In one of these four patients, a 4 cm cyst persisted postoperatively in the hilus of the spleen, but has remained unchanged over an 8-year period. Splenic cysts are usually benign, despite the presence of tumour markers in the cyst wall, and do not require removal. The only indications for surgical intervention are complications (e.g. rupture), symptomatic cysts or asymptomatic cysts with an increased risk of rupture (diameter greater than 5 cm). The very rare parasitic and infective forms must always be surgically sterilized.

19% of 1490 abdominal sonograms from 1192 patients led to findings which were not related to the original purpose of the sonogram or to the actual disease, and of which neither the treating physician nor the patient were aware. The most frequent findings were those in liver, kidneys and gallbladder. The majority of ultrasonographically detected lesions were benign; tumour diseases were suspected only in 26 cases. The incidence of such findings increased with the patients' age. The positive, predictive value of the findings was around 90%. In 20% of the patients with unexpected findings, further diagnostic measures were taken; therapeutic consequences were recorded in only twelve cases. Further measures were recommended in 20% of the patients, a majority of which had pancreatic and vascular abnormalities. Because such findings may considerably facilitate the diagnosis of subsequent complaints, all accessible organs should be examined during abdominal ultrasonography.