Endoscopic Underrunning Suture for Post Splenectomy Gastric Necrosis

Abstract

Aim: Gastric necrosis post splenectomy carries a high risk of mortality and should be identified and diagnosed early. Presentation of Case: We would like to report a case of a 57 years-old lady who was involved in an alleged motor vehicle accident (MVA) sustaining a grade V splenic injury and then underwent an exploratory laparotomy with splenectomy. Discussion: Emergency splenectomies have been known to carry devastating complications such as gastric necrosis, pancreatic duct injury causing fistula and overwhelming post-splenectomy infection (OPSI). Gastric necrosis is a rare event, only reported in less than 1% of splenectomies. Conclusion: We advocate that endoscopy is a safe and feasible method in diagnosing the extent of gastric necrosis and able to manage the bleeding from the slough from gastric mucosa by using endoscopic clips and by injecting adrenaline. However, in case of extensive bleeding from the gastric mucosa, an exploratory laparotomy with on table endoscopic underruning suture at the source of bleeding at the gastric fundus can help to avoid a partial gastrectomy.