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Splenosis involving the gastric fundus, a rare cause of massive upper gastrointestinal bleeding: a case report and review of the literature

View Article: PubMed Central - PubMed

ABSTRACT

Splenosis, the autotransplantation of splenic tissue following splenic trauma, is uncommonly clinically significant. Splenosis is typically diagnosed incidentally on imaging or at laparotomy and has been mistakenly attributed to various malignancies and pathological conditions. On the rare occasion when splenosis plays a causative role in a pathological condition, a diagnostic challenge may ensue that can lead to a delay in both diagnosis and treatment. The following case report describes a patient presenting with a massive upper gastrointestinal bleed resulting from arterial enlargement within the gastric fundus secondary to perigastric splenosis. The cause of the bleeding was initially elusive and this case highlights the importance of a thorough clinical history when faced with a diagnostic challenge. Treatment options, including the successful use of transarterial embolization in this case, are also presented.

No MeSH data available.


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CT images of perigastric splenosis pre- and postembolization of the perfusing network.Notes: (A) Selected contrast enhanced axial CT images acquired before (A, C, and E) and after (B, D, and F) embolization of an enlarged branch of the left inferior phrenic artery artery (as depicted by the solid arrows in A, B, C, and D) perfusing a grouping of perigastric splenosis. (B) and (D) reveal near complete resolution of the tortuous component of the gastric branch traversing the wall of the gastric fundus. The dashed arrow in (C) and (D) reveals a corresponding marked reduction in size of the extramural component of the gastric branch leading to perigastric splenosis. The solid arrows in axial images E and F reveal the dominant nodule within the grouping of perigastric splenosis.Abbreviation: CT, computed tomography.
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f1-ceg-9-301: CT images of perigastric splenosis pre- and postembolization of the perfusing network.Notes: (A) Selected contrast enhanced axial CT images acquired before (A, C, and E) and after (B, D, and F) embolization of an enlarged branch of the left inferior phrenic artery artery (as depicted by the solid arrows in A, B, C, and D) perfusing a grouping of perigastric splenosis. (B) and (D) reveal near complete resolution of the tortuous component of the gastric branch traversing the wall of the gastric fundus. The dashed arrow in (C) and (D) reveals a corresponding marked reduction in size of the extramural component of the gastric branch leading to perigastric splenosis. The solid arrows in axial images E and F reveal the dominant nodule within the grouping of perigastric splenosis.Abbreviation: CT, computed tomography.

Mentions: The patient continued to have melena stool and a subsequent CT angiogram was acquired revealing an extensive network of enlarged arteries within the wall of the gastric fundus that were supplying a grouping of splenosis along the posterior aspect of the gastric fundus (Figure 1). The dominant arterial supply was localized to a branch of the left inferior phrenic artery, which underwent successful transarterial coil embolization that was confirmed on a follow-up CT scan (Figures 1 and 2). The patient clinically improved, his hemoglobin stabilized, and he was ultimately discharged home.


Splenosis involving the gastric fundus, a rare cause of massive upper gastrointestinal bleeding: a case report and review of the literature
CT images of perigastric splenosis pre- and postembolization of the perfusing network.Notes: (A) Selected contrast enhanced axial CT images acquired before (A, C, and E) and after (B, D, and F) embolization of an enlarged branch of the left inferior phrenic artery artery (as depicted by the solid arrows in A, B, C, and D) perfusing a grouping of perigastric splenosis. (B) and (D) reveal near complete resolution of the tortuous component of the gastric branch traversing the wall of the gastric fundus. The dashed arrow in (C) and (D) reveals a corresponding marked reduction in size of the extramural component of the gastric branch leading to perigastric splenosis. The solid arrows in axial images E and F reveal the dominant nodule within the grouping of perigastric splenosis.Abbreviation: CT, computed tomography.
© Copyright Policy
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5036825&req=5

f1-ceg-9-301: CT images of perigastric splenosis pre- and postembolization of the perfusing network.Notes: (A) Selected contrast enhanced axial CT images acquired before (A, C, and E) and after (B, D, and F) embolization of an enlarged branch of the left inferior phrenic artery artery (as depicted by the solid arrows in A, B, C, and D) perfusing a grouping of perigastric splenosis. (B) and (D) reveal near complete resolution of the tortuous component of the gastric branch traversing the wall of the gastric fundus. The dashed arrow in (C) and (D) reveals a corresponding marked reduction in size of the extramural component of the gastric branch leading to perigastric splenosis. The solid arrows in axial images E and F reveal the dominant nodule within the grouping of perigastric splenosis.Abbreviation: CT, computed tomography.
Mentions: The patient continued to have melena stool and a subsequent CT angiogram was acquired revealing an extensive network of enlarged arteries within the wall of the gastric fundus that were supplying a grouping of splenosis along the posterior aspect of the gastric fundus (Figure 1). The dominant arterial supply was localized to a branch of the left inferior phrenic artery, which underwent successful transarterial coil embolization that was confirmed on a follow-up CT scan (Figures 1 and 2). The patient clinically improved, his hemoglobin stabilized, and he was ultimately discharged home.

View Article: PubMed Central - PubMed

ABSTRACT

Splenosis, the autotransplantation of splenic tissue following splenic trauma, is uncommonly clinically significant. Splenosis is typically diagnosed incidentally on imaging or at laparotomy and has been mistakenly attributed to various malignancies and pathological conditions. On the rare occasion when splenosis plays a causative role in a pathological condition, a diagnostic challenge may ensue that can lead to a delay in both diagnosis and treatment. The following case report describes a patient presenting with a massive upper gastrointestinal bleed resulting from arterial enlargement within the gastric fundus secondary to perigastric splenosis. The cause of the bleeding was initially elusive and this case highlights the importance of a thorough clinical history when faced with a diagnostic challenge. Treatment options, including the successful use of transarterial embolization in this case, are also presented.

No MeSH data available.


Related in: MedlinePlus