Post-traumatic rupture of primary solid pseudopapillary epithelial neoplasm (SPEN) of the pancreas in a male adolescent: a case report

Solid pseudopapillary epithelial neoplasm (SPEN) is a rare pancreatic tumor that typically presents in adult women and is usually asymptomatic. A 12-year-old male presented to the emergency department with worsening abdominal pain one day after suffering mild abdominal trauma during a soccer match. Physical exam showed diffuse abdominal tenderness and guarding. CT abdomen with IV contrast showed a heterogeneous, round structure adjacent to the pancreatic tail with mass effect upon the spleen. MRI abdomen revealed a “claw sign” of pancreatic tissue surrounding the structure, suggesting a an underlying pancreatic mass with capsular rupture measuring 8.3 x 8.1 × 8cm. This finding indicated the need for open distal pancreatectomy. Intraoperatively, safe separation of the splenic vasculature from the mass proved impossible and splenectomy was performed. A drain was left in place. Postoperatively, the patient recovered without complication. At one month follow-up, the patient was seen doing well. A drain amylase did not show evidence of a pancreatic leak and was removed. Histopathology later confirmed the diagnosis of SPEN of the pancreas. Traumatic rupture of SPEN of the pancreas is a rare initial presentation. Distal pancreatectomy shortly after presentation appears to be safe and may require splenectomy if the splenic vasculature appears inseparable from the tumor.