Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2018; 6(15): 1047-1052
Published online Dec 6, 2018. doi: 10.12998/wjcc.v6.i15.1047
Endoscopic titanium clip closure of gastric fistula after splenectomy: A case report
Jing Yu, Cheng-Ji Zhou, Pan Wang, Shou-Jiang Wei, Jin-Song He, Jin Tang
Jing Yu, Cheng-Ji Zhou, Pan Wang, Shou-Jiang Wei, Jin-Song He, Jin Tang, Department of Gastrointestinal Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
Jing Yu, Cheng-Ji Zhou, Pan Wang, Sichuan Key Laboratory of Medical Imaging, Nanchong 637000, Sichuan Province, China
Author contributions: Yu J and Zhou CJ contributed equally to this work; Yu J, Zhou CJ, and Wang P wrote the manuscript; Yu J, Zhou CJ, Wang P, Wei SJ, He JS, and Tang J diagnosed and treated the patient; all authors discussed the results and commented on the manuscript.
Supported by the Program of Central Financial Support for Local Universities of China, No. SCKBMI-13-004; and the Project of Sichuan Provincial Health Bureau of China, No. 130334.
Informed consent statement: The patient agreed to the publication of the article and signed the consent form.
Conflict-of-interest statement: All authors declare that they have no financial or personal relationships with other people or organizations that could inappropriately influence (bias) their work.
CARE Checklist (2016) statement: The manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Pan Wang, MD, Associate Professor, Department of Gastrointestinal Surgery, Affiliated Hospital of North Sichuan Medical College, Sichuan Key Laboratory of Medical Imaging, 63 Wenhua Road, Nanchong 637000, Sichuan Province, China. wpan@nsmc.edu.cn
Telephone: +86-817-2262417 Fax: +86-817-2262417
Received: August 3, 2018
Peer-review started: August 6, 2018
First decision: October 5, 2018
Revised: November 8, 2018
Accepted: November 14, 2018
Article in press: November 15, 2018
Published online: December 6, 2018
Processing time: 125 Days and 8.2 Hours
ARTICLE HIGHLIGHTS
Case characteristics

A 52-year-old male patient with blunt abdominal traumatic rupture of the spleen developed a gastric fistula after splenectomy. Following conservative treatment in a local hospital for almost 3 wk that was ineffective, he was transferred to our hospital.

Clinical diagnosis

The patient was diagnosed with a gastric fistula and abdominal infection.

Differential diagnosis

Pancreatic fistula should be excluded.

Laboratory diagnosis

Laboratory examination showed that the white blood cell count, percentage of neutrophils, and high sensitivity C-reactive protein level were significantly increased.

Imaging diagnosis

A fistula of the greater curvature of the gastric body accompanied by abdominal infection was confirmed by upper digestive tract ioversol angiography and dynamic abdominal computed tomography scanning.

Treatment

Anti-infective treatment and nutritional support was ineffective for the fistula of the patient. Therefore, endoscopic titanium clip closure was performed and the gastric fistula was successfully closed.

Experiences and lessons

As conservative treatment may be ineffective for medium-sized gastric fistulas after splenectomy, endoscopic titanium clipping is a good and safe treatment choice, which avoids the risk of re-operation.