{
  "abstract": "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.",
  "authors": [
    {
      "affiliations": [
        "Gastroenterology, Southend University Hospital NHS Foundation Trust, Westcliff-On-Sea, UK"
      ],
      "name": "Heba El Bashir Mustafa"
    },
    {
      "affiliations": [
        "Gastroenterology, Southend University Hospital NHS Foundation Trust, Westcliff-On-Sea, UK",
        "Gastroenterology, Mid and South Essex NHS Foundation Trust, Basildon, UK"
      ],
      "name": "Faisal Zahedi"
    }
  ],
  "title": "Massive upper gastrointestinal haemorrhage from splenic artery erosion secondary to gastro-gastric fistula following single-anastomosis gastric bypass",
  "uid": "abac1a84-86cc-5037-a6c9-a64feab0c22a"
}