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Case Reports
. 2016 Sep 22:9:301-305.
doi: 10.2147/CEG.S91835. eCollection 2016.

Splenosis involving the gastric fundus, a rare cause of massive upper gastrointestinal bleeding: a case report and review of the literature

Jason Reinglas  1 , Kirstin Perdrizet  1 , Stephen E Ryan  2 , Rakesh V Patel  1
Affiliations
Case Reports

Splenosis involving the gastric fundus, a rare cause of massive upper gastrointestinal bleeding: a case report and review of the literature

Jason Reinglas et al. Clin Exp Gastroenterol. .

Abstract

Splenosis, the autotransplantation of splenic tissue following splenic trauma, is uncommonly clinically significant. Splenosis is typically diagnosed incidentally on imaging or at laparotomy and has been mistakenly attributed to various malignancies and pathological conditions. On the rare occasion when splenosis plays a causative role in a pathological condition, a diagnostic challenge may ensue that can lead to a delay in both diagnosis and treatment. The following case report describes a patient presenting with a massive upper gastrointestinal bleed resulting from arterial enlargement within the gastric fundus secondary to perigastric splenosis. The cause of the bleeding was initially elusive and this case highlights the importance of a thorough clinical history when faced with a diagnostic challenge. Treatment options, including the successful use of transarterial embolization in this case, are also presented.

Keywords: UGIB; endoscopy; intervention; therapeutic.

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Figures

Figure 1
Figure 1
CT images of perigastric splenosis pre- and postembolization of the perfusing network. Notes: (A) Selected contrast enhanced axial CT images acquired before (A, C, and E) and after (B, D, and F) embolization of an enlarged branch of the left inferior phrenic artery artery (as depicted by the solid arrows in A, B, C, and D) perfusing a grouping of perigastric splenosis. (B) and (D) reveal near complete resolution of the tortuous component of the gastric branch traversing the wall of the gastric fundus. The dashed arrow in (C) and (D) reveals a corresponding marked reduction in size of the extramural component of the gastric branch leading to perigastric splenosis. The solid arrows in axial images E and F reveal the dominant nodule within the grouping of perigastric splenosis. Abbreviation: CT, computed tomography.
Figure 2
Figure 2
Selective angiogram and embolization of a gastric branch of the left phrenic artery perfusing the largest splenic nodule. Notes: (A) Selective angiogram of a markedly enlarged gastric branch of the left phrenic artery perfusing the largest splenic nodule of a grouping of perigastric splenosis (arrow). The dashed line approximates the component of the artery traversing the wall of the gastric fundus. (B) Selective angiogram following successful embolization of the gastric branch with multiple coils (arrows). The dashed arrow identifies ascending branch of left inferior phrenic artery.
See this image and copyright information in PMC

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