Lethal arrosion of a splenic artery by a lymphoma

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A 69-year-old female patient was admitted to receive CAR T-cell therapy for her primary refractory stage IV diffuse large B-cell lymphoma. Initial diagnosis had been made 11 months before in the context of an upper GI bleeding from an ulcerating stomach tumor. Upon admission, the patient had stable disease. By day+8 the patient presented with fulminant hematemesis triggering immediate transfer to ICU. The patient was admitted with a blood pressure of 80/50 mmHg and tachycardia of 130 bpm, also showing centralization and reduced vigilance. Protective intubation was performed with a short resuscitation during the procedure due to a PEA. Two vasopressors were required due to rapidly progressive hemodynamic instability. Eight red blood cell concentrates, 4 platelet concentrates, 2 FFP and 4 g Fibrinogen were transfused. Emergency EGD identified severe arterial bleeding in the corpus within an ulcerated area. The initial attempt to control the bleeding with TTSC after injection of adrenalin was unsuccessful, consequently an OTS-clip was applied. With further bleeding next to the primary localization, a second OTS-clip finally achieved successful hemostasis, leading to better sight clearly showing the spleen behind a completely destructed stomach wall. Further detailed inspection detected a large splenic artery as the source of bleeding with no possible further endoscopic interventions. Interventional angiography was also denied because of severe instability. Unfortunately, the patient died from refractory hemorrhagic shock 2.5 hours after ICU admission. Although unproven, fatal bleeding might have been caused by rapid tumor shrinking upon treatment, that might have uncovered large arteries arroded by the lymphoma. Publication History Article published online: 27 March 2025 © 2025. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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