Gastrosplenic Fistula in the Setting of Undiagnosed Lymphoma: A Case Report

A gastrosplenic fistula (GSF) is a pathologic connection between the spleen and stomach that can lead to life-threatening complications. A GSF can arise spontaneously but is often secondary to a variety of etiologies. Most commonly, GSFs arise from gastric or splenic non-Hodgkin diffuse large B-cell lymphomas (DLBCL). Only 46 cases of GSFs have been published to date, and due to its rarity extensive literature review is insufficient for characterization of GSFs.

This case discusses a patient with intermittent abdominal pain and weight loss, which led to the diagnosis and treatment of a GSF and DLBCL. The patient later went into remission for his DLBCL but succumbed to respiratory failure from a secondary abdominal-pleural fistula formation. Gastrosplenic fistulas have the potential to cause fatal, massive, upper gastrointestinal hemorrhages, infections, other fistulas, or esophageal obstructions. A delay in diagnosis corresponds with a higher morbidity and mortality; thus, prompt detection and treatment are imperative. The management of GSFs is complex and requires a multidisciplinary approach to care.

In this report we review GSFs in the emergency care setting with the goal of increasing awareness to facilitate their diagnosis.