When organs collide: A rare cause of gastrointestinal bleeding

A 72-year-old man was referred to our Emergency Department with a 2-week history of melaena. His medical history was relevant for Atrial Fibrillation and Non-Hodgkin's Lymphoma (NHL) in remission on most recent PET. Our patient responded to resuscitative management and then went on to have upper gastrointestinal endoscopic evaluation to elucidate the cause of bleeding. As seen in the images, endoscopy showed a gross defect in fundal wall with evidence of extrinsic infiltration by a large vascular mass-like structure, suspected to be spleen. Computed tomography (CT) abdomen and pelvis confirmed a gastrosplenic fistula as well as new lymphadenopathy. The findings were in keeping with recurrence of NHL. Discussion at multidisciplinary meeting deemed his gastrosplenic fistula unsuitable for surgical repair. He was managed conservatively, had a nasojejunal (NJ) tube inserted for feeding, and clinically improved on the ward. Our patient expressed a preference not to undergo further chemotherapy, having struggled quite significantly with his initial chemotherapy. He was discharged home 23 days following admission. At this stage, his NJ tube was removed and he was tolerating oral diet. He is currently being managed by the Palliative Care team in the community.