Gastrosplenic fistula: etiologies, diagnostic studies, and surgical management

A gastrosplenic fistula is a rare event. Reported causes include a spontaneous malignant fistula, chemotherapy for gastric or splenic malignancies, peptic ulcer disease, Crohn disease, and trauma. We report a case of a gastrosplenic fistula discovered on abdominal computed tomography with contrast, performed in a patient with a history suspicious for malignancy. In this case, no etiology was identified prior to the surgical repair of the lesion despite extensive workup. Due to continued gastrointestinal blood loss requiring multiple transfusions, the patient was taken to surgery for splenectomy and partial gastrectomy. It was at that time that the diagnosis of a large B-cell lymphoma was made. Postoperative chemotherapy was initiated and led to remission of the malignancy. Though most cases require definitive surgical repair, the treatment plans for gastrosplenic fistulas depend largely on the etiology of the lesion.