Frenkel Amit, Bichovsky Yoav, Perry Zvi H, Peiser Jochanan, Roy-Shapira Aviel, Brotfain Evgeni, Koyfman Leonid, Binyamin Yair, Nalbandyan Karen, Klein Moti
General Intensive Care Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Department of General Surgery, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Ann Med Surg (Lond). 2018 Mar 31;29:26-29. doi: 10.1016/j.amsu.2018.03.025. eCollection 2018 May.
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.
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.
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.
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.
胃脾瘘（GSF）是一种非常罕见的并发症，主要源于脾脏或胃的大细胞淋巴瘤。胃底与肿大且脆弱的脾脏相邻，这可能促使瘘管形成。这种并发症可导致大量出血，虽然不常见，但可能致命。我们报告一例因胃脾瘘继发大量上消化道出血的患者。
我们报告一名48岁患有难治性弥漫性大B细胞淋巴瘤的男性，因呕血入院。入院时，他处于失血性休克状态，被直接送往重症监护病房。胃镜检查未能确定出血来源，患者血流动力学仍不稳定，遂进行剖腹探查。发现脾动脉一个分支与胃之间存在瘘管。胃似乎也参与了恶性病变过程。行胃次全切除术和脾切除术后，出血得到控制。病情稳定后，患者被收入重症监护病房，24小时后病情稳定出院。
我们描述了一例脾动脉一个分支与胃之间的瘘管，并伴有大量出血。急诊剖腹探查挽救了患者生命。
本报告的目的是提醒医生，在这种罕见的恶性疾病中，手术干预可能挽救生命。本文还对胃脾瘘的症状表现和流行病学进行了文献综述。
