Case History
A 41-year-old man with a history of oculodentodigital dysplasia, spastic
paraplegia and sacral decubitus ulcers with diverting sigmoid colostomy,
chronic back pain on baclofen pump presented with malaise and melena
through colostomy. He admitted intermittent use of NSAIDs for chronic
back pain. On arrival to ER, he was tachycardic (113/min), with a BP of
126/82 mmHg and pale appearing. His Hgb was 4.9 g/dL (baseline Hgb 12.1
g/dL). CT angiogram of the abdomen/pelvis was negative for active
contrast extravasation, however, revealed direct contiguity between the
gastric fundus and spleen indicating GSF (figure 1). The patient was
resuscitated with IV fluid and required multiple blood transfusions.
Splenic artery (SA) angiogram showed hyperemia along the posterior wall
of the stomach corresponding to CT findings of GSF (figure 2).
Embolization of the main SA, right gastroepiploic, and left omental
artery was performed (figure 3). An EGD showed a benign inflammatory
mass in the gastric fundus with the invasion of splenic tissue into the
gastric mucosa (figure 4). A gastric biopsy was negative for H. pylori
and malignancy, however, revealed mild chronic inflammation and reactive
gastropathy. Patient was managed with partial gastrectomy and
splenectomy. Operative findings were consistent with a large type V
gastric ulcer at the fundus with direct extension into the spleen.
Pathology of operative specimen demonstrated transmural granulation
tissue and acute inflammation with acute serositis and mucosal
ulceration without evidence of ischemia. He was discharged to rehab
after a prolonged hospital course.