A 76-year-old man presented with general malaise and weight loss for the past year and lower left chest pain for the past month. He had a medical history of hypertension and type 2 diabetes mellitus. Laboratory data showed an increased serum lactate dehydrogenase level at 232 U/L and markedly increased soluble interleukin-2 receptor level at 2,854 U/mL. Plain computed tomography (CT) revealed gastric wall thickening and the presence of air in the spleen (Picture 1A). He was diagnosed with gastrosplenic fistula by enhanced CT (Picture 1B). Upper gastrointestinal endoscopy detected a fistula in the fundus of the stomach (Picture 2, arrows). The pathological diagnosis of the gastric biopsy was diffuse large B-cell lymphoma, not otherwise specified (NOS) (Picture 3). Gastrosplenic fistula is a rare entity, commonly caused by gastric or splenic lymphoma (1,2). The presence of air in the spleen warrants the consideration of a gastrosplenic fistula caused by a malignancy, such as lymphoma.
Picture 1.
Picture 2.
Picture 3.
The authors state that they have no Conflict of Interest (COI).
References
- 1.Frenkel A, Bichovsky Y, Perry ZH, et al. Management of gastrosplenic fistula in the emergency setting - a case report and review of the literature. Ann Med Surg (Lond) 29: 26-29, 2018. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Kang DH, Huh J, Lee JH, Jeong YK, Cha HJ. Gastrosplenic fistula occurring in lymphoma patients: systematic review with a new case of extranodal NK/T-cell lymphoma. World J Gastroenterol 23: 6491-6499, 2017. [DOI] [PMC free article] [PubMed] [Google Scholar]