PMC9876717_01
A: Wide-ranging gastric varices in the upper body. B: A small fistula within the gastric varices (white arrow). C: A gastric fistula. D: Severe stenosis in the splenic flexure of the colon. E: Multiple longitudinal ulcer scars from the descending colon to the sigmoid colon. F: A rectal-vaginal fistula (white arrow). A-C: Upper gastrointestinal endoscopy. D-F: Colonoscopy.
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Colonoscopy revealed severe stenosis due to inflammatory polyps in the splenic flexure, which could not be passed, multiple longitudinal ulcer scars from the descending colon to the sigmoid colon, and a huge rectal-vaginal fistula in the lower rectum (Fig. 1).
A: A long fistula from the stomach to the descending colon (yellow arrows). B: A long fistula from the descending colon to the stomach (yellow arrows) and severe stenosis in the transverse colon (red arrow). C: A rectal-vaginal fistula in the lower rectum (yellow arrow). A-C: A radiographic image enhanced by amidotrizoate sodium meglumine.
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A radiographic image enhanced by amidotrizoate sodium meglumine showed a long fistula from the stomach to the descending colon, severe stenosis in the transverse colon, and a rectal-vaginal fistula in the lower rectum (Fig. 2).
A: Gastric varices in the gastric wall (white arrow). B: Fistula formation from the upper stomach to the hilum of the spleen with splenomegaly (white arrow). C: The long fistula from the stomach [white arrow (A)] to the descending colon [white arrow (B)]. D: Gastric varices formation in the short gastric vein (yellow arrow), narrowing of the splenic vein (green arrow), and collateral circulation development. A: A contrast-enhanced image. B: An amidotrizoate sodium meglumine-enhanced image. C: A three-dimensionally reconstructed image.
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Furthermore, the gastric varices in the short gastric vein, narrowing of the splenic vein, and collateral circulation development were clearly demonstrated on a three-dimensional (3D) reconstructed image (Fig. 3).
A Thrombus in the splenic vein in the splenectomy specimen. A: 20-fold magnification of Hematoxylin and Eosin staining (H&E), B: 20-fold magnification of Elastica van Gieson (EvG) staining. C: 100-fold magnification of EvG staining.
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The pathological findings after surgery demonstrated multiple nonspecific ulcer scars in the terminal ileum and throughout the colon, multiple inflammatory polyps with a fistula in the splenic flexure of the colon, an abscess with a fistula in the stomach, and multiple stenoses and thrombi in the splenic vein in the splenectomy specimen (Fig. 4).
A: Sliding hernia and disappearance of the gastric varices. B: Surgical scar from partial gastrectomy in the upper body. C: Disappearance of the fistula from the stomach. D: Disappearance of gastric varices in the gastric wall. E: Post-splenectomy. A-B: Upper gastrointestinal endoscopy. C: A radiographic image enhanced by amidotrizoate sodium meglumine. D-E: A contrast-enhanced image.
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Furthermore, the huge gastric varices in the gastric wall had completely disappeared on enhanced CT of the abdomen (Fig. 5).