Rare Dual Complication: Splenic Extension and Gastric Rupture of a Pancreatic Pseudocyst in a Middle Age Patient with Acute Abdomen and Hematemesis

Pancreatic pseudocysts are a common complication of acute and chronic pancreatitis, yet rupture into adjacent organs, such as the stomach or spleen, remains a rare event. This case report details a 45-year-old man with a history of alcohol-induced acute pancreatitis who presented with acute abdominal pain and hematemesis. Imaging and endoscopic evaluation revealed a pancreatic pseudocyst in the tail extending into the spleen, and also with rupture into the stomach causing hematemesis. Conservative management was initially pursued, but clinical deterioration necessitated surgical intervention. An emergency laparotomy revealed ruptured splenic tissue with extensive peripancreatic inflammation. A splenectomy and gastro cystic anastomosis were performed, with a favorable postoperative recovery. This case highlights the rare presentation of pancreatic pseudocyst rupture into both the spleen and stomach, emphasizing the importance of a tailored, multidisciplinary approach to management. Conservative treatment can be effective in stable patients, but surgical intervention remains crucial for those with hemodynamic instability or significant complications.