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Case Reports
. 2018 Mar 31:29:26-29.
doi: 10.1016/j.amsu.2018.03.025. eCollection 2018 May.

Management of gastrosplenic fistula in the emergency setting - A case report and review of the literature

Amit Frenkel  1 , Yoav Bichovsky  1 , Zvi H Perry  2 , Jochanan Peiser  2 , Aviel Roy-Shapira  1   2 , Evgeni Brotfain  1 , Leonid Koyfman  1 , Yair Binyamin  3 , Karen Nalbandyan  4 , Moti Klein  1
Affiliations
Case Reports

Management of gastrosplenic fistula in the emergency setting - A case report and review of the literature

Amit Frenkel et al. Ann Med Surg (Lond). .

Abstract

Introduction: A gastrosplenic fistula (GSF) is a very rare complication that arises mainly from a splenic or gastric large cell lymphoma. The proximity of the gastric fundus to the enlarged fragile spleen may facilitate the fistulisation. This complication can lead to massive bleeding, which, though uncommon, may be lethal. We present a patient with massive upper gastrointestinal bleeding secondary to a GSF.

Case presentation: We present a 48-year-old man with a refractory diffuse large B-cell lymphoma who was admitted to our hospital due to hematemesis. On arrival, he was in hemorrhagic shock, and was taken directly to the intensive care unit. The source of bleeding could not be identified on gastroscopy, the patient remained hemodynamically unstable and a laparotomy was performed.A fistula between a branch of the splenic artery and the stomach was identified. The stomach appeared to be involved in the malignant process. After subtotal gastrectomy and splenectomy, the bleeding was controlled. After stabilization, the patient was admitted to the intensive care unit, and 24 hours later was discharged in stable condition.

Discussion: We describe a fistula between a branch of the splenic artery and the stomach, which was accompanied by massive bleeding. An emergency laparotomy saved the patient's life.

Conclusion: The purpose of this report is to alert physicians that surgical intervention can be lifesaving in this rare malignant condition. A literature review focusing on the presenting symptoms and the epidemiology of GSF is presented.

Keywords: Case report; Gastrosplenic fistula; Hematemesis; Lymphoma; Shock.

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Figures

Fig. 1
Fig. 1
Background diseases. This graph represents the distribution of background diseases that presented in 28 patients described in the literature.
Fig. 2
Fig. 2
Patient age. This graph represents the age distribution and the mean age of the patients described in the literature.
Fig. 3
Fig. 3
Presenting symptoms. This graph represents the distribution of presenting symptoms of the 28 cases described in the literature.
Fig. 4
Fig. 4
Gastrectomy specimen. Transmural infiltration of the gastric wall by medium to large atypical cells with vesicular nuclei and, in part, with clear cytoplasm. Areas of necrosis, involving whole thickness of the muscularis propria were seen.
Fig. 5
Fig. 5
PAX5 positive. Gastric wall cells stained positive for PAX5.
See this image and copyright information in PMC

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