Korean J Gastroenterol.  2015 Sep;66(3):168-171. 10.4166/kjg.2015.66.3.168.

A Case of Splenic Tuberculosis Forming a Gastro-splenic Fistula

• Lee KJ
• Yoo JS
• Jeon H
• Cho SK
• Lee JH
• Ha SS
• Cho MY
• Kim JW

• KMID: 2373334
• DOI: http://doi.org/10.4166/kjg.2015.66.3.168

Abstract

We report a case of a 61-year-old man who presented with a cough and abdominal discomfort. CT scan of the chest showed two lesions across both lungs, and an abdominal CT scan revealed multiple hypodense lesions in the spleen with cystic lesions on the splenic hilum. Upper gastrointestinal tract endoscopy found creamy yellowish discharge through a fistula between the stomach and splenic hilum. Under fluoroscopic guidance, forceps was inserted into the fistula tract, and forcep biopsy was done. The pathology was consistent with tuberculosis, and a nine-month anti-tuberculosis medication regimen was started. Imaging performed three months after finishing medication indicated improvement of splenic lesions, and the gastro-splenic tract was sealed off. This case is a very rare clinical example of secondary splenic tuberculosis with a gastro-splenic fistula formation in an immunocompetent patient.

Keyword

Tuberculosis, splenic; Gastro-splenic fistula; Granuloma

MeSH Terms

Antitubercular Agents/therapeutic use
Fluoroscopy
Gastric Fistula/pathology
Gastroscopy
Humans
Male
Middle Aged
Spleen/diagnostic imaging/pathology
Splenic Diseases/*diagnosis/diagnostic imaging/pathology
Tomography, X-Ray Computed
Tuberculosis, Splenic/*diagnosis/drug therapy/microbiology
Ultrasonography
Antitubercular Agents