An Unusual Differential Diagnosis of Gastric Haemorrhage: A Rare Case of Gastrosplenic Fistula

Abstract

A gastrosplenic fistula is a rare complication of primary splenic lymphoma and a rare cause of massive upper gastrointestinal haemorrhage. We report a case of a spontaneous gastrosplenic fistula secondary to splenic large B-cell lymphoma. The patient was admitted to the emergency department with haematemesis. Oesophagogastroduodenoscopy showed a deep gastric ulcer, and a subsequent CT scan revealed a gastrosplenic fistula. Gastric biopsy demonstrated gastric mucosa with infiltration by large lymphoid cells. A multidisciplinary discussion on the management of this case was conducted. Primary surgical treatment of the fistula was not deemed indicated because the bleeding had stopped. The patient was stabilized, transfused, and then transferred to the oncology unit for chemotherapy. During hospitalization, lung metastases were found but the progressive worsening of the patient’s general condition contraindicated chemotherapy. She was transferred to a hospice and died 2 months later of neoplastic cachexia. Gastrosplenic fistula is a rare condition. Prompt recognition of the underlying pathology can save the patient’s life. We aim to highlight this rare complication of splenic lymphoma, discuss the presenting signs and symptoms, and explore the management options.