Splenic Arteriogastric Fistula Resulting from Adrenocortical Carcinoma: A Rare Cause of Massive Upper Gastrointestinal Hemorrhage

Elias J. Dayoub, Kyung J. Cho

Department of Radiology, Division of Vascular & Interventional Radiology, University of Michigan Health System, Ann Arbor, USA.
University of Michigan Medical School, Ann Arbor, USA;John F. Kennedy School of Government, Harvard University, Cambridge, USA.

DOI: 10.4236/ojrad.2013.34027                

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.

Keywords

Splenic Artery; Fistula; Pseudoaneurysm; Adrenocortical Carcinoma; Embolization

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	L. Rebibo, D. Fuks, C. Blot, B. Robert, P. O. Boulet, A. Dhahri, P. Verhaeghe and J. M. Regimbeau, “Gastrointestinal Bleeding Complication of Gastric Fistula after Sleeve Gastrectomy: Consider Pseudoaneurysms,” Surgical Endoscopy, Vol. 27, No. 8, 2013, pp. 2849-2855. http://dx.doi.org/10.1007/s00464-013-2833-7
[2]	S. S. Morse, B. N. Siskind, N. R. Horowitz and E. B. Strauss, “Splenic Arteriogastric Fistula from Plication of a Gastric Ulcer. Therapeutic Embolization,” Journal of Clinical Gastroenterology, Vol. 9, No. 4, 1987, pp. 480482. http://dx.doi.org/10.1097/00004836-198708000-00026
[3]	E. Moreno González, A. García Ocana, J. Hebrero Sanmartin, M. Moreno Azcoita, A. Belda Serna, and J. L. Rodriguez Agullo, “Fistula between the Splenic Artery and the Gastric Cavity as an Exceptional Complication of Peptic Ulcer. Report of a Case,” Revista Espanola de las Enfermedades del Aparto Digestivo, Vol. 53, No. 5, 1978, pp. 543-554.
[4]	T. Cioppa, A. De Stefano, D. Marrelli, A. Neri, S. Rossi, G. De Marco, E. Pinto and F. Roviello, “Pseudoaneurysm of the Splenic Artery Fistulized in the Stomach and Associated to a Pancreatic Pseudocyst: Case Report,” Minerva Chirurgica, Vol. 61, No. 3, 2006, pp. 261-264.
[5]	T. Nakazawa, M. Kida, S. Kokubu, S. Tanabe, A. Shibuya, K. Matsunaga and K. Saigenji, “Massive Gastrointestinal Hemorrhage from Pseudocyst with Fistula and Splenic Artery Aneurysm Rupture,” Endoscopy, Vol. 31, No. 3, 1999, p. S23.
[6]	D. A. Toroptsev, A. V. Anisimov and F. S. Zhizhin, “Gastrointestinal Hemorrhage Caused by Rupture of Aneurysm of the Splenic Artery into the Stomach,” Vestnik Khirurgii Imeni I. I. Grekova, Vol. 145, No. 10, 1990, pp. 42-43.
[7]	A. N. Barkun, M. Bardou, E. J. Kuipers, R. H. Hunt, M. Martel, P. Sinclair and International Consensus Upper Gastrointestinal Bleeding Conference Group, “International Consensus Recommendations on the Management of Patients with Nonvariceal Upper Gastrointestinal Bleeding,” Annals of Internal Medicine, Vol. 152, No. 2, 2010, pp. 101-113.
[8]	G. A. Agrawal, P. T. Johnson and E. K. Fishman, “Splenic Artery Aneurysms and Pseudoaneurysms: Clinical Distinctions and CT Appearances,” American Journal of Roentgenology, Vol. 188, No. 4, 2007, pp. 992-999. http://dx.doi.org/10.2214/AJR.06.0794
[9]	D. C. Madoff, A. Denys, M. J. Wallace, R. Murthy, S. Gupta, E.P. Pillsbury, K. Ahrar, B. Bessoud and M. E. Hicks, “Splenic Arterial Interventions: Anatomy, Indications, Technical Considerations, and Potential Complications,” Radiographics, Vol. 25, Suppl. 1, 2005, pp. S191S211. http://dx.doi.org/10.1148/rg.25si055504