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Borgharia S, Juneja P, Hazrah P, Lal R, Kapur N, Chaudhary P. Gastrosplenic Fistula: a Systematic Review. Indian J Surg Oncol 2022; 13:652-660. [PMID: 36187537 PMCID: PMC9515263 DOI: 10.1007/s13193-022-01551-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/19/2022] [Indexed: 11/09/2022] Open
Abstract
Gastrosplenic fistula is an unusual complication of benign as well as malignant gastric and splenic pathologies. This pathology acquires an important clinical significance due to its rare association with life-threatening upper gastrointestinal haemorrhage. The aim of this article is to review the English-language literature in order to gain a better understanding of etiological factors, diagnostic evaluation, and management of gastrosplenic fistula. The systematic search of the literature was performed on PubMed and MEDLINE from January 1950 to September 2020 according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. We retrieved 44 articles matching our selection criteria from the search. There were 3 case series, 37 case reports, and 4 review of the literature. In our appraisal of articles published in PUBMED, a total of 36 cases of malignant and 10 cases of benign gastrosplenic fistula could be identified. Gastrosplenic fistula is an exceptional complication of malignancies of the gastrointestinal tract. Lymphomas particularly arising from the spleen are the commonest cause. Gastric adenocarcinoma causing GSF is extremely rare. Most cases occur spontaneously, but at times, it can be secondary to tumour necrosis following chemotherapy.
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Affiliation(s)
- Saurabh Borgharia
- Department of General Surgery, Lady Hardinge Medical College, New Delhi, India
| | - Preeti Juneja
- Department of General Surgery, Lady Hardinge Medical College, New Delhi, India
| | - Priya Hazrah
- Department of General Surgery, Lady Hardinge Medical College, New Delhi, India
| | - Romesh Lal
- Department of General Surgery, Lady Hardinge Medical College, New Delhi, India
| | - Neeti Kapur
- Department of General Surgery, Lady Hardinge Medical College, New Delhi, India
| | - Poras Chaudhary
- Department of General Surgery, Lady Hardinge Medical College, New Delhi, India
- Atal Bihari Vajpayee Institute of Medical Sciences &, Dr Ram Manohar Lohia Hospital, New Delhi, India
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2
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Khdhir M, El Annan T, El Amine MA, Shareef M. Complications of lymphoma in the abdomen and pelvis: clinical and imaging review. Abdom Radiol (NY) 2022; 47:2937-2955. [PMID: 35690955 PMCID: PMC10509750 DOI: 10.1007/s00261-022-03567-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 01/18/2023]
Abstract
Involvement of the abdomen and pelvis is common in lymphoma. Nodal and extranodal abdominal and pelvic lymphoma may present with various complications. Complications are most common in high-grade lymphomas, especially diffuse large B-cell lymphoma. Complications may occur as the initial manifestation of lymphoma, during treatment course, or late following complete disease remission. Most complications are associated with worse prognosis and increased mortality. Imaging is essential in evaluation of disease extent and diagnosis of complications. Therefore, radiologists should be familiar with the clinical context and imaging features of abdominal and pelvic lymphoma complications. We provide a comprehensive, organ system-based approach, and clinical and imaging review of complications of abdominal and pelvic lymphoma along with radiologic images of illustrated cases of the most commonly encountered complications.
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Affiliation(s)
- Mihran Khdhir
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Riad El-Solh, PO Box 11-0236, Beirut, 1107 2020, Lebanon.
| | - Tamara El Annan
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Riad El-Solh, PO Box 11-0236, Beirut, 1107 2020, Lebanon
| | | | - Muhammed Shareef
- Department of Radiology and Biomedical Imaging, Yale New Haven Hospital, New Haven, CT, USA
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3
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Bülbül H, Irak K, Berk S, Ulusoy Y, Ayer M. SPONTANEOUS GASTROSPLENIC FISTULA: AN UNUSUAL PRESENTATION OF DIFFUSE LARGE B CELL LYMPHOMA. Gastroenterol Nurs 2022; 45:63-66. [PMID: 35020633 DOI: 10.1097/sga.0000000000000637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 06/30/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Hale Bülbül
- Hale Bülbül, MD, is a hematologist at Tepecik Training and Research Hospital, İzmir, Turkey
- Kader Irak, MD, is a gastroenterologist at Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
- Selin Berk, MD, is a hematologist at Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
- Yusuf Ulusoy, MD, is a hematologist at Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
- Mesut Ayer, MD, is an associate professor and the head of Hematology Department at Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
| | - Kader Irak
- Hale Bülbül, MD, is a hematologist at Tepecik Training and Research Hospital, İzmir, Turkey
- Kader Irak, MD, is a gastroenterologist at Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
- Selin Berk, MD, is a hematologist at Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
- Yusuf Ulusoy, MD, is a hematologist at Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
- Mesut Ayer, MD, is an associate professor and the head of Hematology Department at Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
| | - Selin Berk
- Hale Bülbül, MD, is a hematologist at Tepecik Training and Research Hospital, İzmir, Turkey
- Kader Irak, MD, is a gastroenterologist at Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
- Selin Berk, MD, is a hematologist at Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
- Yusuf Ulusoy, MD, is a hematologist at Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
- Mesut Ayer, MD, is an associate professor and the head of Hematology Department at Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
| | - Yusuf Ulusoy
- Hale Bülbül, MD, is a hematologist at Tepecik Training and Research Hospital, İzmir, Turkey
- Kader Irak, MD, is a gastroenterologist at Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
- Selin Berk, MD, is a hematologist at Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
- Yusuf Ulusoy, MD, is a hematologist at Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
- Mesut Ayer, MD, is an associate professor and the head of Hematology Department at Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
| | - Mesut Ayer
- Hale Bülbül, MD, is a hematologist at Tepecik Training and Research Hospital, İzmir, Turkey
- Kader Irak, MD, is a gastroenterologist at Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
- Selin Berk, MD, is a hematologist at Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
- Yusuf Ulusoy, MD, is a hematologist at Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
- Mesut Ayer, MD, is an associate professor and the head of Hematology Department at Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
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4
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Hand-assisted laparoscopic approach for the treatment of gastrosplenic fistula: A case report and review of the literature. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2020. [DOI: 10.1016/j.lers.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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5
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Gastro-Splenic Fistula Related to Large B Cell Lymphoma. REPORTS 2020. [DOI: 10.3390/reports3020017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report a case of spontaneous gastrosplenic fistula in a 57 year old female who presented to the emergency department with abdominal pain and weight loss. From the physical examination, she had a palpable abdominal mass. A CT scan was performed and showed a mass involving the proximal greater curve of the stomach, infiltrating the spleen and pancreas. There was a 12 mm defect in the cardia of the stomach with gas entering the large mass but there was no free gas in the abdomen. The defect was a gastrosplenic fistula. A gastroscopic biopsy confirmed the diagnosis of diffuse large B cell lymphoma. Surgical removal of the mass was not feasible; therefore she was treated with RCHOP chemotherapy, achieving complete remission.
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Eso Y, Uza N, Shirakawa K, Sawada K, Katsuragi K, Matsuura M, Seno H. Choledochoduodenal Fistula during Chemotherapy with Brentuximab Vedotin for Methotrexate-associated Lymphoproliferative Disorder. Intern Med 2018; 57. [PMID: 29526961 PMCID: PMC6120836 DOI: 10.2169/internalmedicine.0557-17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report a patient with a history of rheumatoid arthritis treated with methotrexate, which caused methotrexate-associated lymphoproliferative disorder and obstructive jaundice due to an enlarged lymph node. The obstructive jaundice was treated with endoscopic biliary stenting. A histopathological examination revealed features of Hodgkin's lymphoma, and chemotherapy with brentuximab vedotin was administered. Cholangiography and duodenoscopy after four rounds of chemotherapy revealed a choledochoduodenal fistula that developed in response to chemotherapy. It should be noted that, in cases of lymphoma infiltrating the gastrointestinal wall, fistulae can occur because of rapid regression due to regimens comprising monoclonal antibodies, such as rituximab and brentuximab vedotin.
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Affiliation(s)
- Yuji Eso
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Japan
| | - Norimitsu Uza
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Japan
| | - Kotaro Shirakawa
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Japan
| | - Kenji Sawada
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Japan
| | - Kentaro Katsuragi
- Integrated Clinical Education Center, Kyoto University Hospital, Japan
| | - Minoru Matsuura
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Japan
| | - Hiroshi Seno
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Japan
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Kang DH, Huh J, Lee JH, Jeong YK, Cha HJ. Gastrosplenic fistula occurring in lymphoma patients: Systematic review with a new case of extranodal NK/T-cell lymphoma. World J Gastroenterol 2017; 23:6491-6499. [PMID: 29085199 PMCID: PMC5643275 DOI: 10.3748/wjg.v23.i35.6491] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/20/2017] [Accepted: 07/24/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To provide the overall spectrum of gastrosplenic fistula (GSF) occurring in lymphomas through a systematic review including a patient at our hospital.
METHODS A comprehensive literature search was performed in the MEDLINE database to identify studies of GSF occurring in lymphomas. A computerized search of our institutional database was also performed. In all cases, we analyzed the clinicopathologic/radiologic features, treatment and outcome of GSF occurring in lymphomas.
RESULTS A literature search identified 25 relevant studies with 26 patients. Our institutional data search added 1 patient. Systematic review of the total 27 cases revealed that GSF occurred mainly in diffuse, large B-cell lymphoma (n = 23), but also in diffuse, histiocytic lymphoma (n = 1), Hodgkin’s lymphoma (n = 2), and NK/T-cell lymphoma (n = 1, our patient). The common clinical presentations are constitutional symptoms (n = 20) and abdominal pain (n = 17), although acute gastrointestinal bleeding (n = 6) and infection symptoms due to splenic abscess (n = 3) are also noted. In all patients, computed tomography scanning was very helpful for diagnosing GSF and for evaluating the lymphoma extent. GSF could occur either post-chemotherapy (n = 10) or spontaneously (n = 17). Surgical resection has been the most common treatment. Once patients have recovered from the acute illness status after undergoing surgery, their long-term outcome has been favorable.
CONCLUSION This systematic review provides an overview of GSF occurring in lymphomas, and will be helpful in making physicians aware of this rare disease entity.
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MESH Headings
- Abdominal Abscess/diagnostic imaging
- Abdominal Abscess/epidemiology
- Abdominal Abscess/etiology
- Abdominal Abscess/surgery
- Abdominal Pain/diagnostic imaging
- Abdominal Pain/epidemiology
- Abdominal Pain/etiology
- Abdominal Pain/surgery
- Acute Disease/epidemiology
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Dialysis
- Gastric Fistula/diagnostic imaging
- Gastric Fistula/epidemiology
- Gastric Fistula/etiology
- Gastric Fistula/surgery
- Gastrointestinal Hemorrhage/diagnostic imaging
- Gastrointestinal Hemorrhage/epidemiology
- Gastrointestinal Hemorrhage/etiology
- Gastrointestinal Hemorrhage/surgery
- Hepatomegaly/diagnostic imaging
- Hepatomegaly/etiology
- Herpesvirus 4, Human/genetics
- Herpesvirus 4, Human/isolation & purification
- Humans
- Lymphoma/complications
- Lymphoma/drug therapy
- Lymphoma, Extranodal NK-T-Cell/complications
- Lymphoma, Extranodal NK-T-Cell/diagnostic imaging
- Lymphoma, Extranodal NK-T-Cell/therapy
- Lymphoma, Extranodal NK-T-Cell/virology
- Male
- Middle Aged
- Neoplasm Recurrence, Local/diagnostic imaging
- Neoplasm Recurrence, Local/therapy
- Positron-Emission Tomography
- RNA, Viral/isolation & purification
- Spleen/diagnostic imaging
- Spleen/pathology
- Spleen/surgery
- Spleen/virology
- Splenectomy
- Splenic Diseases/diagnostic imaging
- Splenic Diseases/epidemiology
- Splenic Diseases/etiology
- Splenic Diseases/surgery
- Splenomegaly/diagnostic imaging
- Splenomegaly/etiology
- Stem Cell Transplantation
- Stomach/diagnostic imaging
- Stomach/pathology
- Stomach/surgery
- Stomach/virology
- Tomography, X-Ray Computed
- Transplantation, Autologous
- Treatment Outcome
- Tumor Lysis Syndrome/etiology
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Affiliation(s)
- Dong Hyeok Kang
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 682-714, South Korea
| | - Jimi Huh
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 682-714, South Korea
| | - Jong Hwa Lee
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 682-714, South Korea
| | - Yoong Ki Jeong
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 682-714, South Korea
| | - Hee Jeong Cha
- Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 682-714, South Korea
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Yabuuchi Y, Matsubayashi H, Matsuzaki M, Shiomi A, Moriguchi M, Kawamura I, Ito I, Ono H. Colovesical fistula caused by glucocorticoid therapy for IgG4-related intrapelvic mass. World J Clin Cases 2015; 3:1000-1004. [PMID: 26677450 PMCID: PMC4677080 DOI: 10.12998/wjcc.v3.i12.1000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 08/19/2015] [Accepted: 10/13/2015] [Indexed: 02/05/2023] Open
Abstract
IgG4-related disease (IgG4-RD) is an immune-mediated fibroinflammatory disorder that can occur in almost all systemic organs and generally responds to corticosteroid treatment. We report a rare case of an IgG4-related intrapelvic mass lesion that responded to steroid therapy but caused a fistula between the sigmoid colon and bladder. A 71-year-old man was followed after treatment for hepatocellular carcinoma. Follow-up computed tomography (CT) incidentally depicted left hydronephrosis with an ill-demarcated intrapelvic mass lesion. This lesion was histologically diagnosed as IgG4-RD by open biopsy, and peroral steroid therapy was initiated. One month after starting steroids, a colovesical fistula was detected by follow-up CT. A colostomy and urethral catheterization were emergently performed. The patient recovered and the mass lesion was drastically minimized by the initiation of glucocorticoids; however, he still needs urethral catheterization. IgG4-RD develops in various systemic organs and generally responds well to steroids. Clinicians must be watchful for the complications of responses to corticosteroids, such as fistulization, when the mass lesion of IgG4-RD is adjacent to multiple luminal organs.
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9
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Asymptomatic gastrosplenic fistula in a patient with marginal zonal lymphoma transformed to diffuse large B cell lymphoma--a case report and review of literature. Ann Hematol 2013; 93:1599-602. [PMID: 24362455 DOI: 10.1007/s00277-013-1986-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 12/02/2013] [Indexed: 12/28/2022]
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10
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Ashkenazi I, Olsha O, Kessel B, Krausz MM, Alfici R. Uncommon acquired fistulae involving the digestive system: summary of data. Eur J Trauma Emerg Surg 2011; 37:259-67. [PMID: 26815108 DOI: 10.1007/s00068-011-0112-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Accepted: 04/16/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Most gastrointestinal fistulae commonly occur following surgery. A minority is caused by a myriad of other etiologies and is termed by some as "uncommon fistulae". The aim of this study was to review these fistulae and their treatment. METHODS A literature review was carried out. Searches were conducted in Pubmed and related references reviewed. RESULTS Except for Crohn's disease and diverticulitis, "uncommon fistulae" are described in case reports or very small case series. Most of the patients were treated by surgery. CONCLUSIONS The anatomic features of the fistula and the etiology usually dictate the approach. Most patients will eventually need surgery to resolve this pathology.
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Affiliation(s)
- I Ashkenazi
- Surgery B Department, Hillel Yaffe Medical Center, P.O. Box 169, Hadera, 38100, Israel.
| | - O Olsha
- Surgery Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - B Kessel
- Trauma Unit, Hillel Yaffe Medical Center, Hadera, Israel
| | - M M Krausz
- Surgery B Department, Hillel Yaffe Medical Center, P.O. Box 169, Hadera, 38100, Israel
| | - R Alfici
- Surgery B Department, Hillel Yaffe Medical Center, P.O. Box 169, Hadera, 38100, Israel
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11
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Khan F, Vessal S, McKimm E, D'Souza R. Spontaneous gastrosplenic fistula secondary to primary splenic lymphoma. BMJ Case Rep 2010. [PMID: 22791483 DOI: 10.1136/bcr.04.2010.2932.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A gastrosplenic fistula is a rare complication of gastric and splenic lymphomas which can occur spontaneously or secondary to chemotherapy. We report a case of a spontaneous gastrosplenic fistula secondary to a diffuse splenic large B cell lymphoma in a previously well 43-year-old patient. CT imaging demonstrated the fistula, which was subsequently managed with chemotherapy. The clinical management of this rare condition is discussed with a review of the literature.
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Affiliation(s)
- Faraan Khan
- Department of General Medicine, Barnet and Chase Farm NHS Trust, London, UK.
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12
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Khan F, Vessal S, McKimm E, D'Souza R. Spontaneous gastrosplenic fistula secondary to primary splenic lymphoma. BMJ Case Rep 2010; 2010:2010/oct18_2/bcr0420102932. [PMID: 22791483 DOI: 10.1136/bcr.04.2010.2932] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
A gastrosplenic fistula is a rare complication of gastric and splenic lymphomas which can occur spontaneously or secondary to chemotherapy. We report a case of a spontaneous gastrosplenic fistula secondary to a diffuse splenic large B cell lymphoma in a previously well 43-year-old patient. CT imaging demonstrated the fistula, which was subsequently managed with chemotherapy. The clinical management of this rare condition is discussed with a review of the literature.
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Affiliation(s)
- Faraan Khan
- Department of General Medicine, Barnet and Chase Farm NHS Trust, London, UK.
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13
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Seib CD, Rocha FG, Hwang DG, Shoji BT. Gastrosplenic Fistula From Hodgkin's Lymphoma. J Clin Oncol 2009; 27:e15-7. [DOI: 10.1200/jco.2008.21.7695] [Citation(s) in RCA: 542] [Impact Index Per Article: 36.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Carolyn D. Seib
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Flavio G. Rocha
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Dick G. Hwang
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Brent T. Shoji
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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