TITLE:
Splenic Arteriogastric Fistula Resulting from Adrenocortical Carcinoma: A Rare Cause of Massive Upper Gastrointestinal Hemorrhage
AUTHORS:
Elias J. Dayoub, Kyung J. Cho
KEYWORDS:
Splenic Artery; Fistula; Pseudoaneurysm; Adrenocortical Carcinoma; Embolization
JOURNAL NAME:
Open Journal of Radiology,
Vol.3 No.4,
December
24,
2013
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.