Gastric perforation as a complication of splenectomy: report of five cases and review of the literature

Abstract

A rare complication of splenectomy is gastric perforation and fistula. Patients with this complication often complain of pain in the left upper quadrant and left shoulder, and of fever, tachycardia and upper abdominal tenderness. Chest radiographs often show a pleural effusion in the left hemithorax. Patients usually exhibit increased drainage from the tube in the left upper quadrant or a collection of fluid in the left subphrenic space. The diagnosis can be confirmed by radiography after ingestion of meglumine diatrizoate (Gastrografin). Treatment by nasogastric suction and adequate drainage of the left subphrenic space allows some of these fistulas to close. In some cases operative closure is necessary. With appropriate treatment, 75% of these patients can be expected to recover.