Splenic Salvage Following Iatrogenic Splenic Artery Injury Post-gastrectomy

Radical gastrectomy, a standard procedure for gastric cancer treatment, is associated with several postoperative complications, including bleeding, abscess formation, anastomosis leakage, wound issues, pancreatic fistulas, and ileus. Among these, splenic artery injuries leading to splenic infarction (SI) are relatively common. SI often resolves spontaneously, leading to under-recognition, and its overall incidence post-gastrectomy is not well established. Severe SI complications, such as hemorrhage, abscess formation, or rupture, can be life-threatening and may require splenectomy or completion total gastrectomy. Early diagnosis is challenging due to nonspecific symptoms. Surgical challenges include post-chemotherapy fibrosis, lymph nodal encasement of the splenic artery, and the intraparenchymal course of the splenic artery, making identification of splenic artery difficult. Intraoperative iatrogenic injuries to the splenic artery during gastrectomy, though common, are underreported. Typically, splenectomy with vessel ligation are performed for such injuries. This report highlights primary anastomosis of the splenic artery to preserve the spleen in event of iatrogenic injury, emphasizing the importance of intraoperative identification of splenic artery injuries.