Case of the Day(sm)

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Man with abdominal pain and anemia.

Our appreciation is extended to Dr. Audra Brunelle,
Indiana University Department of Radiology,
for contributing this case.

History: Man with abdominal pain and anemia.

An image from the patient's CT is shown below. Please respond to the following with TRUE or FALSE.

Findings are compatible with cirrhosis

True or False

Findings are compatible with varices

True or False

Findings are compatible with peptic ulcer disease

True or False

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Case of the Day(sm)

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Man with abdominal pain and anemia.

Images from a follow-up CT are shown below. Click to enlarge. Patient has had EGD and gastric ulcer biopsy since the CT shown on the previous page.

Which choice below most likely applies to the findings?

Acute venous thrombosis.Gastric perforation.Splenic contusion.B and C.A and C.

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Case of the Day(sm)

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Man with abdominal pain and anemia.

Findings: On the old study there is significantly decreased gastric wall thickness with contrast visualized adjacent to the spleen. On the current study there are surgical clips in this area along with small pockets of gas surrounding the clips. There is a new low density lesion within the spleen adjacent to these clips.

Differential diagnosis:

Gastric ulcer with perforation
Gastric malignancy
Splenic contusion secondary to trauma
Splenic metastasis

Actual diagnosis: Gastric ulcer with small perforation during biopsy. Focal splenic contusion secondary to trauma from aggressive attempt at hemostasis of ulcer after biopsy.

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Case of the Day(sm)

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Man with abdominal pain and anemia.

Key points:

Splenic injury during upper GI endoscopy is an incredibly rare complication. So far, only a few case reports have been published describing such injury. Most have occurred during ERCP.
Splenic injury is also a rare complication of colonoscopy, though is more common than with upper endoscopy. There have been 66 reported cases as of 2008. More than half of these cases resulted in some form of therapeutic intervention (for the splenic injury) needing to be performed.

References:

Splenic laceration after ERCP. Hong Kong Med Journal 2008; 14:145-147.
Splenic injury: a rare complication of ERCP. Am Surg 2004; 70: 737-739.
Splenic injury complicating therapeutic upper gastrointestinal endoscopy and ERCP. Gastrointestinal endoscopy; 1991; 37: 6: 632.

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