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Gastric Fistula as a Complication of Splenectomy: Case Report and Literature Review
hematoma at splenic bed with fistula tract connecting as abrasions or denudement of serosal covering of the
the perforated fundus ulcer to the hematoma. greater curvature of the stomach resulting from a techni-
The hematoma was evacuated completely with exci- cally difficult splenectomy, interruption of a reflection of
sion of the fistula tract and the lesion at stomach fundus gastric muscle fibers into the gastrosplenic ligament at
was around 2 × 2 cm and was sutured after revival of its the attachment to the stomach wall. This condition was
borders with simple stiches on two planes. demonstrated by Whitesell. 11
The patient was discharged 2 weeks postoperatively Decreased vascularity, especially in elderly patients
in a good general condition. with arterosclerotic disease of the gastric vasculature,
may also predispose to gastric fistula postsplenectomy.
DISCUSSION And severe trauma with multiple injuries or any condi-
tion predisposes to stress ulceration.
The stomach has exuberant arterial blood irrigation,
which makes the organ resistant toward postoperative CONCLUSION
1
ischemic changes. Several studies have demonstrated
the rich intramural and extramural anastomotic network Gastric perforation and fistula formation should be sus-
1,2
by experiments. Nevertheless, there are some surgical pected when a patient who has had splenectomy presents
procedures that interfere to a greater or lesser extent with unfavorable postoperative evolution. Awareness of the
the blood supply, such that reports of gastric necrosis and possibility of this uncommon but serious complication
gastric perforation are becoming more frequent. 3,4 will aid in its early recognition and treatment.
Classically, this complication has been thought to
be secondary to direct trauma to gastric wall by surgi- REFERENCES
5
cal instrumentation. An area of necrosis presumably 1. Barlow TE, Bentley FH, Walder DN. Arteries, veins and
appears high on the posterior gastric wall and is fol- arteriovenous anastomosis in human stomach. Surg Gynecol
lowed by ulceration and perforation. At the apex of the Obstel 1951 Dec;93(6):657-671.
triangular-shaped gastrosplenic omentum, the superior 2. Souza LA. Micro-hemocirculation do stomach: aspectos
pole of the spleen is in its closest proximity to the stomach. morfologicos e functionaris [tese]. Lisboa: Faculadade de
In the course of ligation of the short gastric arteries in the Medicina de Lisboa; 1974.
apex of this triangle, direct injury to the stomach wall 3. Lambert R, Bugnon B, Partensky C, Saubier E. Ulcer gastric
procedure après vagotomy hyperselective and drainage. Arch
may occur. In describing the technique of splenectomy, Fr Mal App Dig 1976 Jan-Feb;65(1):41-46.
6-9
various authors have cautioned against inadvertent 4. Schein M, Saadia R. Postoperative gastric ischaemia. Br J Surg
instrumentation of this area of the stomach. In spite of 1989 Aug;76(8):844-848.
this precaution and careful surgical technique, gastric 5. Bryk D, Petigrow N. Postsplenectomy gastric perforation.
fistulas still do occur following splenectomy. Surgery 1967 Feb;61(2):239-241.
One of the rarest conditions which may predispose 6. Balfour DC. Surgery of the spleen. Collect Papers Mayo Clinic
1917;9:375.
to a gastric fistula following splenectomy is the presence 7. Ballinger WF, Erslev AJ. Splenectomy. Curr Probl Surg 1965
of organizing hematoma with inflammatory reaction in Feb:35.
the gastrosplenic omentum adjacent to the gastric wall 8. Mayo WJ. Surgery of the spleen. Surg Gynecol Obstet
secondary to rupture of the spleen, which was published 1913;16:233.
by Harrison et al. 10 9. Poole EH, Stillman RG. Surgery of the spleen. New York:
In this case study, we believe that the organized huge Appleton and Co; 1923. p. 318.
hematoma was the leading cause for the stomach perfora- 10. Harrison BJ, Glanges E, Sparkman RS. Gastric fistula follow-
ing splenectomy: its cause and prevention. Ann Surg 1977
tion as it led to compression necrosis on the fundus wall. Feb;185(2):210-213.
There are other several conditions which may pre- 11. Whitesell FB. A Clinical and surgical anatomic study of the
dispose to gastric fistula following splenectomy, such spleen. Surg Gynecol Obstet 1960;110:750.

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