Subeena Phull

University of Pennsylvania

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Karun Neupane

Jacobi Medical Center

Ebubekir Daglilar

Charleston Area Medical Center

Hamza Ertugrul

University of Missouri

Muhammad Nadeem Yousaf

University of Missouri

Vinayak Aryal

MetroHealth Medical Center

Riyasha Dahal

College of Medical Sciences

Aryal Vinayak

MetroHealth Medical Center

Tahan Veysel

University of Missouri

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University of Missouri

MetroHealth Medical Center

Case Western Reserve University

Charleston Area Medical Center

West Virginia University

University of Missouri Hospital

MetroHealth

Nepal Cancer Hospital and Research Center

Larkin Community Hospital

Islamic Azad University, Tehran

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Type V gastric ulcer: An unusual etiology of gastrosplenic fistula associated with upper gastrointestinal bleeding

Clinical Case Reports (2024)

Muhammad Nadeem Yousaf Riyasha Dahal Subeena Phull Vinayak Aryal Karun Neupane

Type V gastric ulcer is an unusual etiology of gastrosplenic fistula (GSF). Prompt diagnosis and early embolization of splenic vessels prior to esophagogastroduodenoscopy and surgical resection is crucial.

Esophagogastroduodenoscopy

Etiology

Upper Gastrointestinal Bleeding

10.1002/ccr3.8518

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S2596 Gastro-Splenic Fistula: A Rare Cause of Upper Gastrointestinal Bleeding

The American Journal of Gastroenterology (2022)

Muhammad Nadeem Yousaf Subeena Phull Aryal Vinayak Karun Neupane Hamza Ertugrul

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 (Figure 1). 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.Figure 1.: CT angiogram (A) shows wedge shaped defect between gastric fundus and spleen indicating gastrosplenic fistula (arrow). Angiography of the splenic artery (B) shows extravasation of blood along the posterior wall of the stomach corresponding to the site of ulceration on the CT scan. Splenic artery angiogram after Gelfoam slurry, coil, and Amplatzer embolization (C). CT abdomen/pelvis after embolization of the main SA, right gastroepiploic, and left omental artery (D). EGD shows a large benign gastric tumor in the gastric fundus, consistent with splenic tissue invading the gastric mucosa (E and F).

Gastro-

Upper Gastrointestinal Bleeding

Gastrointestinal bleeding

10.14309/01.ajg.0000867024.84324.7a

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Type V Gastric Ulcer: An Unusual Etiology of Gastrosplenic Fistula Associated with Upper Gastrointestinal Bleeding

Authorea (Authorea) (2023)

Muhammad Nadeem Yousaf Riyasha Dahal Subeena Phull Vinayak Aryal Karun Neupane

Type V Gastric Ulcer: An Unusual Etiology of Gastrosplenic Fistula Associated with Upper Gastrointestinal BleedingMuhammad Nadeem Yousaf MD1, Riyasha Dahal MBBS2, Subeena Phull MD3, Vinayak Aryal MD4, Karun Neupane MD5, Hamza Ertugrul MD6, Ebubekir Daglilar MD71Department of Medicine, Division of Gastroenterology and HepatologyUniversity of Missouri, Columbia, MO, United States2Department of Medicine, Universal College of Medical Sciences, Bhairahawa, Nepal3Department of Medicine, University of Pennsylvania, Philadelphia, PA, United States4Department of Pathology and Laboratory Medicine, MetroHealth System, Case Western Reserve University, Cleveland, OH, United States5Department of Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States6Department of Medicine, Saint Mary's Hospital, Waterbury, CT, United States7Department of Medicine, Division of Gastroenterology and HepatologyCharleston Area Medical Center, Charleston, WV, United StatesKeywords: Gastric Ulcers, Gastrosplenic fistula, Gastrointestinal bleeding, NSAIDs, Embolization, Endoscopy.Consent statement: Written informed consent was obtained from the patient to publish this report in accordance with the journal's patient consent policy.

Etiology

Upper Gastrointestinal Bleeding

10.22541/au.170004148.81684689/v1

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