Gastric Perforation Necessitating Splenectomy
Kalvin Zee1, Maianh Tran1, Noah Pirozzi1
1Emergency General Surgery, MercyOne Des Moines Medical Center, Des Moines, USA.
Cureus
|November 11, 2024
Summary
A rare case of gastric perforation led to a pill eroding into the splenic hilum. This required surgical repair and splenectomy in a patient with Addison's disease on steroid therapy.
Area of Science:
- Gastroenterology
- Abdominal Surgery
- Radiology
Background:
- Gastric perforations are uncommon but can lead to severe intra-abdominal complications.
- Chronic steroid use, as in Addison's disease, can predispose patients to gastrointestinal complications.
- Splenic erosion is a rare consequence of gastric perforation due to peritoneal irritation.
Observation:
- A 51-year-old female with Addison's disease on chronic steroids presented with symptoms of gastric perforation.
- Computed tomography revealed a posterior gastric perforation with evidence of a foreign body eroding into the splenic hilum.
- The patient exhibited signs of abdominal peritonitis necessitating urgent surgical intervention.
Findings:
- Intraoperative findings confirmed a gastric perforation with a pill that had eroded through the gastric wall and into the splenic hilum.
- The foreign body was identified as a pill, likely ingested and leading to the unusual erosion.
- Surgical management involved a Graham patch repair of the gastric perforation and a splenectomy due to the splenic hilum involvement.
Implications:
- This case highlights an extremely rare complication of gastric perforation, emphasizing the importance of considering unusual foreign body interactions.
- It underscores the potential for gastrointestinal issues in patients with autoimmune diseases on long-term immunosuppression.
- The successful surgical outcome demonstrates the feasibility of managing complex gastric perforations with associated splenic injury.
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