Lecher Mackenzie, Lecher Brian, Tjiattas-Saleski Lindsay
Edward Via College of Osteopathic Medicine, Department of Emergency Medicine, Spartanburg, South Carolina.
Faster Care Inc, Urgent Care, Sumter, South Carolina.
Clin Pract Cases Emerg Med. 2025 May;9(2):161-164. doi: 10.5811/cpcem.34864.
A gastrosplenic fistula (GSF) is a pathologic connection between the spleen and stomach that can lead to life-threatening complications. A GSF can arise spontaneously but is often secondary to a variety of etiologies. Most commonly, GSFs arise from gastric or splenic non-Hodgkin diffuse large B-cell lymphomas (DLBCL). Only 46 cases of GSFs have been published to date, and due to its rarity extensive literature review is insufficient for characterization of GSFs.
This case discusses a patient with intermittent abdominal pain and weight loss, which led to the diagnosis and treatment of a GSF and DLBCL. The patient later went into remission for his DLBCL but succumbed to respiratory failure from a secondary abdominal-pleural fistula formation. Gastrosplenic fistulas have the potential to cause fatal, massive, upper gastrointestinal hemorrhages, infections, other fistulas, or esophageal obstructions. A delay in diagnosis corresponds with a higher morbidity and mortality; thus, prompt detection and treatment are imperative. The management of GSFs is complex and requires a multidisciplinary approach to care.
In this report we review GSFs in the emergency care setting with the goal of increasing awareness to facilitate their diagnosis.
胃脾瘘（GSF）是脾脏与胃之间的病理性连接，可导致危及生命的并发症。GSF可自发出现，但通常继发于多种病因。最常见的是，GSF源于胃或脾脏非霍奇金弥漫性大B细胞淋巴瘤（DLBCL）。迄今为止，仅发表了46例GSF病例，由于其罕见性，广泛的文献综述不足以对GSF进行特征描述。
本病例讨论了一名伴有间歇性腹痛和体重减轻的患者，该症状导致了GSF和DLBCL的诊断与治疗。该患者后来DLBCL病情缓解，但因继发性腹-胸膜瘘形成死于呼吸衰竭。胃脾瘘有可能导致致命的、大量的上消化道出血、感染、其他瘘或食管梗阻。诊断延迟与更高的发病率和死亡率相关；因此，及时检测和治疗至关重要。GSF的管理很复杂，需要多学科护理方法。
在本报告中，我们在急诊护理环境中回顾GSF，目的是提高认识以促进其诊断。
