Life-threatening gastric ulcer bleeding caused by splenic vein erosion following sleeve gastrectomy

Upper gastrointestinal bleeding is a common medical condition associated with high morbidity and mortality, and may occur as a late complication after gastrointestinal surgery. In this report, we present a sleeve gastrectomy patient with hematemesis and hemodynamic instability due to ulcer bleeding caused by splenic vein erosion. A 55-year-old female patient applied to the emergency service with hemorrhagic shock due to the upper gastrointestinal bleeding. The only notable details in the patient’s medical history were hypertension and a sleeve gastrectomy surgery in 2010. Blood pressure was 70/40 mmHg, and heart rate was 145 beats per minute. After a rapid resuscitation, she underwent emergency surgery since hematemesis continued and hemodynamic status was unstable. No hemorrhagic fluid was found in the intraperitoneal space during the exploratory laparotomy. However, when gastrotomy was performed a giant bleeding ulcer was found on the staple line of the previous sleeve gastrectomy, extending into the splenic vein. The patient underwent total gastrectomy, Roux-en-Y esophagojejunostomy, and splenectomy. The patient was discharged on the 10th day after surgery without any complications.

Keywords: Gastric ulcer, sleeve gastrectomy, upper gastrointestinal bleeding