An Unusual Differential Diagnosis of Gastric Haemorrhage: A Rare Case of Gastrosplenic Fistula
  • Claudia Cicchini
    Emergency Department, Sandro Pertini Hospital, Rome
  • Simona Santarelli
    Department of Emergency Medicine, Sandro Pertini Hospital, Rome, Italy
  • Francesco Rocco Pugliese
    Department of Emergency Medicine, Sandro Pertini Hospital, Rome, Italy


Gastrosplenic fistula, gastric haemorrhage, splenic lymphoma


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.



  • Frenkel A, Bichovsky Y, Perry ZH, Peiser J, Roy-Shapira A, Brotfain E, et al. Management of gastrosplenic fistula in the emergency setting - A case report and review of the literature. Ann Med Surg 2018;29:26–29.
  • Maytapa J, Thanapirom K, Kullavanijaya P, Komolmit P. Gastrointestinal: splenic abscesses-related gastrosplenic fistula: unusual complication of meliondosis. J Gastroenterol Hepatol 2018;33:1163.
  • Alsinan A, Alelq M, Alsugair F, Hassan A, Waheed A, Alshomimi S. Gastro-splenic fistula, a rare presentation of sickle cell disease patient with splenic abscess: case report and literature review. Int J Surg Case Rep 2019;57:22–24.
  • Leeds IL, Haut ER. Splenic abscess complicated by gastrosplenic fistula. J Trauma Acute Care Surg 2016;81:612–614.
  • Triantafyllopoulou D, Gkikas I, Adiyodi J, Crossingham I, Al-Islam S, Alam MS, et al. Gastro-splenic fistula related to large B cell lymphoma. Reports 2020;3(2)17.
  • Saito M, Miyashita K, Miura Y, Harada S, Ogasawara R, Izumiyama K, et al. Successful treatment of gastrosplenic fistula arising from diffuse large B-cell lymphoma with chemotherapy: two case reports. Case Rep Oncol 2019;12:376–383.
  • 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 2017;23:6491–6499.
  • Views: 340
    PDF downloads: 228
    HTML downloads: 51

    Published: 2022-08-23
    Issue: 2022: Vol 9 No 8 (view)

    How to cite:
    Cicchini C, Santarelli S, Pugliese FR. An Unusual Differential Diagnosis of Gastric Haemorrhage: A Rare Case of Gastrosplenic Fistula. EJCRIM 2022;9 doi:10.12890/2022_003419.