Gastric necrosis and perforation as a complication of splenectomy. Case report and related references

Abstract

Necrosis of the stomach after isolated splenectomy with the formation of gastrocutaneous fistula is a rare event that occurs in less than 1% of splenectomies. It is more frequent when the removal of the spleen is done because of hematological diseases. Its mortality index can reach 60% and its pathogenesis is controversial, as it may be attributed both to direct trauma of the gastric wall and to ischemic phenomena. Although the stomach may exhibit exuberant arterial blood irrigation, anatomical variations can cause a predisposition towards the appearance of potentially ischemic areas, especially after ligation of the short gastric vessels around the major curvature of the stomach. Once this is diagnosed in the immediate postoperative period, it becomes imperative to reoperate. The surgical procedure will depend on the conditions of the peritoneal cavity and patient's clinic status. The objective of this study was to report on the case of a patient submitted to splenectomy because of closed abdominal traumatism, who then presented peritonitis and percutaneous gastric fistula in the post-operative period. During the second operation, perforations were identified in anterior gastric wall where there had been signs of vascular stress. The lesion was sutured after revival of its borders, and the patient had good evolution. Prompt diagnosis and immediate treatment of this unusual complication are needed to reduce its high mortality rate.

Gastric Necrosis After an Infarction of the Spleen: Report of a Case

“…8 In our patient, however, we detected none of these obvious conditions. In summary, a reduced arterial blood supply and insufficient venous drainage due to massive venous thrombosis at the greater curvature of the stomach may have together played a major role in the development of gastric necrosis in this patient.…”

“…These include bulimia, 1 selective vagotomy, 2 abdominal trauma, 3 and infectious disease. 4 Vascular causes, such as therapeutic transcatheter embolization, 5 infusion of vasopressin, 6 and splenectomy, 7,8 have also been found to cause gastric necrosis. Theoretically, splenic infarction seems to be one of the possible causes of gastric necrosis; to our knowledge, this is the first report that the blood supply to the stomach has been compromised to such an extent that necrosis occurs.…”

Gastric fistula secondary to drainage tube penetration: A report of a rare case

“…Several studies on gastric fistulae following splenectomy have been presented in the literature (15,16). The condition was classically believed to be secondary to direct trauma to the gastric wall from surgical instrumentation.…”

Nécrose gastrique compliquant une gastroparésie

“…On trouve dans la littérature des causes vasculaires [1], infectieuses [2], postchirurgicales (vagotomie [3], chirurgie gastrique [4], splénique [5,6]) et traumatiques [7]). Différents facteurs ont été identifiés comme pouvant favoriser la survenue d'une ischémie gastrique.…”