Abstract
The patient was an 81-year-old man, who was suffering from stage 3 primary malignant lymphoma of the spleen based on the Ahmann classification. Chemotherapy with R-CHOP was started soon after the diagnosis. Three months after beginning chemotherapy, a gastrosplenic fistula due to the malignant lymphoma was revealed during a follow-up computed tomography (CT).
Surgical repair was considered for the fistula, but further chemotherapy was continued because 1) there were no symptoms related to the gastrosplenic fistula, and 2) the prognosis of the primary malignant lymphoma of the spleen was very poor.
Three months later, the patient went into shock due to massive bleeding from the fistula, and underwent an emergency splenectomy, partial gastrectomy, partial resection of the diaphragm and distal pancreatectomy. He recovered from the shock, but died due to rapid progression of the malignant lymphoma 33 days after the operation.
Previous reports suggested that, in cases of gastrosplenic fistula due to primary malignant lymphoma of the spleen, surgical repair might be effective for patients with stage 1 or 2 disease by the Ahmann classification. However, surgical repair is considered to be difficult in stage 3 patients because of their poor prognosis, as was presented in the present case.
