Post-splenectomy gastric perforation- case report and literature review

Gastric perforation is an infrequent postoperative complication following both open and laparoscopic splenectomy. The incidence is estimated to be less than 1% but the fatality rate is higher than 50%.

A 31-year-old man was admitted to the emergency department after he sustained blunt abdominal trauma with a splenic laceration and massive hemoperitoneum. An emergency splenectomy was performed, followed by hospitalization for 6 days. On the fifth day, the drainage tube was removed. The patient died the day after discharge. A forensic autopsy was performed, revealing a perforation in the gastric wall along the greater curvature, adjacent to the operative field. The defect measured 3 x 2 cm, with smooth, yellowish edges. Additionally, a 1-centimeter black linear fragment was present, which could be easily detached. Microscopic examination revealed acute fibrinous and leukocytic peritonitis which was indicative of ischemic necrosis of the gastric wall, areas of necrosis of the surrounding tissues, mixed inflammatory material with eosinophilic filaments, edema, intravascular microthrombi, and fibrin on the serosal surface.

Gastric perforation after splenectomy may result from direct trauma to the gastric wall during surgery. However, it can also be caused by a penetrating, migrated drainage tube.Several conditions may predispose patients to gastric fistulas following splenectomy. Local ischemia of the gastric wall may be a predisposing factor for gastric perforation. In our case, histopathological examination suggested ischemic necrosis of the gastric wall that was recently produced (1 - 2 days before death) as a complication after surgery.