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Hana Alhomoud, Mohamed Mohsen 10.5005/jp-journals-10033-1310
CASE REPORT

Gastric Fistula as a Complication of Splenectomy:

Case Report and Literature Review

2
1 Hana Alhomoud, Mohamed Abdelmohsen

ABSTRACT ference with the vascular supply to the greater curvature
Gastric fistula following splenectomy is a rare but serious occur- may be a factor in fistula formation.
rence, which may result in morbidity or death. Several factors, The objective of this study was to report a case of
acting singly or in combination, may predispose to the develop- gastric perforation after splenectomy due to trauma that
ment of postsplenectomy gastric fistula and perforation. These evolved with necrosis and gastric perforation, which was
include direct surgical trauma to the gastric wall, generalized
arteriosclerotic disease, hematoma in the gastrosplenic bed, successfully dealt with.
and reflection of gastric muscle fibers into the gastrosplenic
ligament. The usual site of rupture of the stomach is along CASE REPORT
the greater curvature in the fundic portion. In circumstances
in which splenectomy is associated with known or suspected A 37-year-old male was admitted to the emergency unit
compromise of the blood supply to this portion of the stomach, after fall from height. Physical examination revealed
a method of enfolding the greater curvature is done to prevent tachypnea, heart rate of 100/minute, and arterial pres-
the development of a gastric perforation or fistula formation. sure of 100/50 mm Hg. He had severe pain in pelvic due
The objective of this study was to report a case of a patient to pelvic fracture. Computed tomography (CT) chest,
who had splenectomy because of closed abdominal trauma.
3 weeks postsurgery, the patient presented with hemateme- abdomen, and pelvis showed grade I splenic injury (in
sis, and the results of investigations showed gastric fistula. accordance with the organ lesion scale of the American
During the second operation, perforation was identified at Association of Trauma Surgery).
gastroesophageal junction resulting from a huge hematoma Patient was shifted to operating theater where pelvic
at postsplenectomy bed. The lesion was sutured after revival fixation was done. Postsurgery, patient developed massive
of its borders, and the patient had good recovery.
Awareness of the possibility of this uncommon but serious deep venous thrombosis (DVT) and kept on anticoagu-
complication will aid in its early recognition and treatment. lant. Five days postsurgery, hemoglobin dropped and
blood pressure too dropped, so resuscitation was done.
Keywords: Gastric fistula, Splenectomy, Stomach rupture.
Urgent abdominal CT showed presence of free abdominal
How to cite this article: Alhomoud H, Abdelmohsen M. Gastric fluid with splenic tear.
Fistula as a Complication of Splenectomy: Case Report and Laparotomy showed the presence of 500 mL of hem-
Literature Review. World J Lap Surg 2017;10(2):80-81.
orrhagic fluid free in peritoneal cavity and a splenic
Source of support: Nil tear involving the hilum. In the course of splenectomy,
Conflict of interest: None the short vessels were carefully individualized and sec-
tioned. The body and fundic regions of the stomach were
inspected without any inadvertent ligatures of the gastric
INTRODUCTION
wall being detected. A drain was fixed at left subphrenic
Delayed perforation of the stomach following splenec- space exteriorized through an opening on the left flank.
tomy is uncommon. Reports of this complication have At the end of the intracavity surgical procedure, the col-
appeared sporadically. The perforation is usually situated oration of the stomach was normal.
high on the greater curvature of the stomach where short Bowel sounds returned on the second operative day,
gastric vessels in the gastrosplenic omentum have been and oral feeding was started. The drain was removed
transected, and the cause has been assumed to be direct after 5 days. Patient was kept on anticoagulants due
injury to the gastric wall. However, it appears that inter- to massive DVT. Ten days post-op patient developed
postsplenectomy hematoma at splenic bed in relation to
stomach fundus and that was treated conservatively by
1 Consultant, Registrar adjusting the anticoagulant dose.
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1,2 Department of Surgery, Al-Sabah Hospital, Kuwait City, Kuwait Three weeks postsurgery, the patient developed
Kingdom of Saudi Arabia hematemesis. Upper endoscopy was done which showed
Corresponding Author: Hana Alhomoud, Consultant, Department perforated necrotic ulcer with bleeding at fundus stomach
of Surgery, Al-Sabah Hospital, Kuwait City, Kuwait, Kingdom of around 2 cm from gastroesophageal junction.
Saudi Arabia, Phone: +966551440610, e-mail: hana_alhomoud@ Patient was submitted to a new surgical intervention.
hotmail.com
Laparotomy showed a huge well-developed organized
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