A Case of Gastrosplenic Fistula Due to Gastric Ischemia

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  • 急性膵炎から胃虚血と脾膿瘍を発症し胃脾瘻を形成した1例

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<p>The patient was a 67-year-old man who had undergone sigmoid colectomy for sigmoid colon cancer 20 years ago. Six years after the operation, subtotal stomach-preserving pancreaticoduodenectomy (gastropancreatic anastomosis) was performed for recurrence in pancreatic head lymph nodes. He was hospitalized for pancreatitis, but hematemesis appeared after admission and endoscopy was performed. The gastric mucosa turned black, suggesting gastric ischemia. Contrast-enhanced CT revealed poor contrast in the stomach, pancreas and spleen, and emergency surgery was performed for suspected multi-organ necrosis. However, no necrosis was observed, so an intestinal fistula was constructed and the operation was completed. CT on day 20 of illness revealed a gastrosplenic fistula and splenic abscess. We attempted conservative treatment and performed CT-guided drainage for splenic abscess. The splenic abscess shrank, but the fistula remained and did not improve easily. On day 79, gastrosplenic fistula closure and splenectomy were performed, and the patient was discharged on day 122. We report this case as a rare example of gastrosplenic fistula, since only one previous case of this condition has been reported in the Central Medical Journal.</p>

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