Gastrosplenic Fistula with Gastrointestinal Bleeding: a Rare and Potentially Fatal Complication After Sleeve Gastrectomy

Background Although the surgical technique is safe and standardized, laparoscopic sleeve gastrectomy (LSG) is associated with serious and potentially life-threatening complications, such as gastric leak and bleeding. Methods In this retrospective study, three French university hospitals reviewed their experience with LSG. Between September 2014 and May 2016, three cases of gastrosplenic fistula complicated by massive upper gastrointestinal hemorrhage (UGIH) were recorded. Results Patient number 1 experienced a massive UGIH 2 months after LSG. After blood transfusion, a transcatheter embolization of the splenic artery branch was successfully performed. Patient number 2 was admitted to the emergency department for massive UGIH 5 years after LSG. After several unsuccessful endoscopic attempts, she underwent a midline laparotomy, and an "en bloc" staple line resection and splenectomy was performed. Patient number 3 arrived at the hospital with an unstable hemodynamic status 16 days after the LSG and was given emergency surgery. She died as a consequence of hemorrhagic shock. Conclusions Post-LSG gastrosplenic fistula (GSF) is a rare and dreaded complication necessitating emergency management. Angiography with arterial embolization seems to be the treatment of choice for GSF following SG, allowing diagnosis and treatment when hemodynamic stability is warranted. In a life-threatening situation, hemostatic splenectomy remains the treatment of choice.