E0312 - Gastro-Splenic Fistula: A Rare Cause of Upper Gastrointestinal Bleeding

Muhammad Nadeem Yousaf, MD¹, Subeena Phull, MD², Aryal Vinayak, MD³, Karun Neupane, MD⁴, Hamza Ertugrul, MD¹, Ebubekir Daglilar, MD¹, Tahan Veysel, MD^1
1University of Missouri, Columbia, MO; ²MedStar Union Memorial Hospital, Baltimore, MD; ³MetroHealth System, Case Western Reserve University, Cleveland, OH; ⁴Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY

Introduction: Gastrosplenic fistula (GSF) is a rare entity. Reported etiologies of GSF are splenic or gastric malignancies, splenic abscess, Crohn’s disease, gastric ulcers, and abdominal trauma. Here, we present a case of GSF from gastric ulcer resulting in life threatening bleeding.

Case Description/Methods: A 41-year-old man with history of oculodentodigital dysplasia, spastic paraplegia, sacral decubitus ulcers with diverting sigmoid colostomy presented with malaise and melenic stools through colostomy. On arrival at ER, he was tachycardiac (113/min), with BP 126/82 mmHg. His Hgb was 4.9 g/dL. CT angiography of the abdomen/pelvis was negative for active contrast extravasation, however, revealed direct contiguity between the gastric fundus and spleen indicating GSF. Patient was resuscitated with IV fluid and required multiple blood transfusions. Splenic artery (SA) angiogram showed hyperemia along the posterior wall of the stomach corresponding to CT scan findings. Embolization of the main SA, right gastroepiploic, and left omental artery was performed. EGD showed benign inflammatory mass in the gastric fundus with invasion of splenic tissue into the gastric mucosa. Gastric biopsy was negative for H. pylori and malignancy, however, revealed mild chronic inflammation and reactive gastropathy. Partial gastrectomy and splenectomy were performed. Operative findings were consistent with a large type V gastric ulcer at the fundus with direct extension into the spleen. He was discharged to rehab after a prolonged hospital course.

Discussion: We present a case of GSF in the setting of type V gastric ulcer which is a rare entity. Gastric biopsies were negative for malignancy, PUD, splenic abscess, or Crohn's disease indicating the idiopathic nature of GSF. Early embolization of splenic vessels is required in hemodynamically unstable patients followed by radical surgical resection such as splenectomy and gastrectomy. A high index of clinical suspicion is required for early identification and management of GSF as massive hemorrhage results in high rate of mortality.



Disclosures:


Muhammad Nadeem Yousaf, MD¹, Subeena Phull, MD², Aryal Vinayak, MD³, Karun Neupane, MD⁴, Hamza Ertugrul, MD¹, Ebubekir Daglilar, MD¹, Tahan Veysel, MD¹. E0312 - Gastro-Splenic Fistula: A Rare Cause of Upper Gastrointestinal Bleeding, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.