Abstract
Splenic arteriogastric fistula is a rare cause of upper gastrointestinal (GI) hemorrhage, only reported a handful of times in the literature. Herein, we present a case of a 49-year-old woman with metastatic adrenocortical carcincoma who developed a fistula between the splenic artery and gastric lumen as a result of local invasion of her primary tumor. This fistula led to several episodes of massive upper GI bleeding. Selective splenic artery embolization was successful in ceasing the GI bleed; however, the intervention was not timely enough for the patient to survive the hemorrhage. We outline several clinical and imaging findings to assist physicians with earlier detection of splenic arteriogastric fistulas, and advocate prophylactic selective splenic artery embolization when this rare but highly fatal entity is discovered.
Highlights
Splenic arteriogastric fistula is a rare cause of gastrointestinal hemorrhage
We are reporting the first case of splenic arteriogastric fistula caused by adrenocortical carcinoma or any other solid tumor
We discuss clinical and imaging findings which aid in identifying splenic arteriogastric fistulas and propose prophylactic selective splenic artery embolization as appropriate management when this rare but highly fatal condition is suspected
Summary
Splenic arteriogastric fistula is a rare cause of gastrointestinal hemorrhage. Reports in the literature have associated this often-fatal condition with suture plication of a giant gastric ulcer, sleeve gastrectomy, severe peptic ulcer disease, and splenic artery aneurysms fistulizing in the setting of pancreatic pseudocysts [1,2,3,4,5,6]. We are reporting the first case of splenic arteriogastric fistula caused by adrenocortical carcinoma or any other solid tumor. We discuss clinical and imaging findings which aid in identifying splenic arteriogastric fistulas and propose prophylactic selective splenic artery embolization as appropriate management when this rare but highly fatal condition is suspected
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