[Splenic rupture after ERCP]. / Milzruptur nach ERCP.

We report on a 52 year old woman, who developed splenic rupture after endoscopic sphincterotomy for multiple biliary stones. After hemorrhagic shock had developed, the diagnosis was established by computed tomography and ultrasound guided paracentesis. The patient was treated by emergency splenectomy. The case report stresses the necessity to be aware of splenic rupture as a rare complication after ERCP. A review of the current literature regarding splenic rupture is provided and mechanisms of splenic trauma and risk factors are discussed.

[Therapy of abdominal and thoracic chylous effusions 18 years after radiation therapy]. / Therapie abdomineller und thorakaler chylöser Ergüsse 18 Jahre nach Radiatio.

Chylothorax and chylascites are rare complications of neoplasm or surgical, but also non-surgical trauma. Extremely rare causes are a subclavian i.v. line, a mesenterical hamartoma, retrosternal goiter, liver cirrhosis, portal vein thrombosis, filariasis, tuberculosis, ruptured aortic aneurysm and radiotherapy. We report on a 60-year-old male with bilateral chylothorax and chylascites resistant to therapy 18 years after irradiation of the iliacal, paraaortal and mediastinal (46 Gray) and the left-sided supraclavicular (40 Gray) lymph nodes for a seminoma (T3N1M0 i.e. IIa, Lugano classification). A fat-free parenteral nutrition was started in order to bring the lymphatic flow down to a minimum. Chyle flow ceased after 3 1/2 weeks of treatment. An oral diet with middle chain triglycerides (MCT-diet), which are transported to the liver via the portal vein instead of the lymphatic system, achieved good control of residual chylous effusions.