Management of Massive Upper Gastrointestinal Hemorrhage Secondary to Gastrosplenic Fistula

Gastrosplenic fistula (GSF) is seen secondary to the development of a fistulous track between the stomach and spleen and/or splenic vessels. It is most commonly seen in patients with diffuse B-cell lymphoma, who usually present with symptoms of abdominal pain and weight loss. GSF has also been seen in patients with gastric adenocarcinoma, Hodgkin's lymphoma, peptic ulcer disease, splenic abscesses, and post gastric sleeve resection. Less than 25% of the patients with GSF may present with upper gastrointestinal bleed (UGIB). This presentation of GSF is common with benign causes including peptic ulcer disease. UGIB secondary to GSF, while rare, requires prompt identification and intervention, to avoid catastrophic outcomes. We discuss the case of a 64-year-old female with GSF, who presented with sentinel bleed followed by hemorrhagic shock, secondary to a B-cell lymphoma, who was managed with a partial gastrectomy, splenectomy, and distal pancreatectomy, with favorable outcomes.