A 55-year-old male presented to the emergency room with epigastric pain radiating to the left hemithorax that worsened with deep inspiration.
His past medical history included recent weight loss of 5 kg. Upon arrival he was hemodynamically stable with a low-grade fever and examination showed a painful epigastric abdomen with defense and no signs of peritoneal irritation.
No palpable peripheral adenopathies were observed.
The chest X-ray showed an elevation of the left hemidiaphragm, and ultrasound showed heterogeneous patchy echostructure suggestive of abscess.
A abdominal-pelvic CT scan showed a thickened gastric wall at the fundus and small gas bubbles in the spleen with suspected intrasplenic collection.
Initially, she was treated with antibiotics and parenteral nutrition with good evolution.
However, at 72 hours, the patient presented a picture of massive embolism and an emergent surgery was indicated.
A tumor-like lesion was observed in the gastric fundus that compromised hylium, splenic parenchyma and also the pancreatic tail was included in the process.
A gastrotomy was performed on the anterior face of the gastric body and aspirated from clots and arterial bleeding from the fundus was observed, so a block resection of gastric fundus, pancreas and tail was performed.
After the surgery, the patient was informed of the condition and the pathology report was a large B-cell gastric lymphoma with non-splenic seizures.
Bone marrow examination showed no evidence of involvement.
