{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T14:13:49Z","timestamp":1780323229011,"version":"3.54.1"},"reference-count":10,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,5,13]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:p>A woman in her 40s presented with massive upper gastrointestinal bleeding a few months after undergoing a single-anastomosis gastric bypass. CT abdomen and pelvis showed a marginal ulcer with adjacent inflammatory change and suspected colo-enteric fistulation. Endoscopy identified a bleeding fistulous tract; in the context of presumed Roux-en-Y anatomy, this was interpreted as a likely gastro-colic fistula, although diagnostic certainty was limited. Angiography failed to localise active extravasation. Emergency laparotomy ultimately confirmed single-anastomosis anatomy with a gastro-gastric fistula and erosion into the splenic artery. The patient required staged damage-control surgery including resection of the gastric remnant and splenectomy, followed by delayed reconstruction 1 year later. This case highlights diagnostic challenges in altered postbariatric anatomy and the potential for catastrophic vascular complications arising from fistulating marginal ulcer disease.<\/jats:p>","DOI":"10.1136\/bcr-2026-272115","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T13:10:15Z","timestamp":1780319415000},"page":"e272115","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Massive upper gastrointestinal haemorrhage from splenic artery erosion secondary to gastro-gastric fistula following single-anastomosis gastric bypass"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-3929-7028","authenticated-orcid":false,"given":"Heba","family":"El Bashir Mustafa","sequence":"first","affiliation":[{"name":"Gastroenterology, Southend University Hospital NHS Foundation Trust, Westcliff-On-Sea, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4445-0484","authenticated-orcid":false,"given":"Faisal","family":"Zahedi","sequence":"additional","affiliation":[{"name":"Gastroenterology, Southend University Hospital NHS Foundation Trust, Westcliff-On-Sea, UK"},{"name":"Gastroenterology, Mid and South Essex NHS Foundation Trust, Basildon, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,1]]},"reference":[{"key":"2026060106100929000_19.6.e272115.1","first-page":"351","article-title":"Imaging after bariatric surgery: normal anatomy and complications","volume":"41","author":"Fidler","year":"2021","journal-title":"Radiographics"},{"key":"2026060106100929000_19.6.e272115.2","first-page":"176","article-title":"Marginal ulcer after gastric bypass: a prospective 3-year study of 173 patients","volume":"14","author":"Sapala","year":"2004","journal-title":"Obes Surg"},{"key":"2026060106100929000_19.6.e272115.3","doi-asserted-by":"publisher","DOI":"10.1055\/s-0030-1256951"},{"key":"2026060106100929000_19.6.e272115.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.soard.2005.07.003"},{"key":"2026060106100929000_19.6.e272115.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.soard.2006.10.011"},{"key":"2026060106100929000_19.6.e272115.6","article-title":"Splenic artery pseudoaneurysm rupture causing massive gastrointestinal bleeding 14 years post gastric bypass","volume":"11","author":"Hussan","year":"2019","journal-title":"Cureus"},{"key":"2026060106100929000_19.6.e272115.7","first-page":"3893","article-title":"Splenic complications after bariatric surgery: a review","volume":"30","author":"Alahmadi","year":"2020","journal-title":"Obes Surg"},{"key":"2026060106100929000_19.6.e272115.8","first-page":"e1","article-title":"Gastrocolic fistula after bariatric surgery: a rare but serious complication","volume":"34","author":"Boules","year":"2024","journal-title":"Obes Surg"},{"key":"2026060106100929000_19.6.e272115.9","first-page":"843","article-title":"Management of non-variceal upper gastrointestinal bleeding: international consensus guidelines","volume":"68","author":"Barkun","year":"2019","journal-title":"Gut"},{"key":"2026060106100929000_19.6.e272115.10","first-page":"1","article-title":"Management of post-bariatric bleeding: endoscopic and interventional approaches","volume":"56","author":"Toh","year":"2023","journal-title":"Clin Endosc"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-272115","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T13:10:17Z","timestamp":1780319417000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-272115"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":10,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6,1]]},"published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1136\/bcr-2026-272115"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-272115","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]}}}