Introduction: A gastrosplenic fistula (GSF) is a pathologic connection between the spleen and stomach that can lead to life threatening complications.  A GSF can arise spontaneously but is often secondary to a variety of etiologies.  Most commonly, GSFs arise from gastric or splenic non-Hodgkin’s diffuse large B-cell lymphomas.  Only 46 cases of GSFs have been published to date and due to its rarity, extensive literature review is insufficient for characterization of GSFs. 

Case Report: This case discusses a patient with intermittent abdominal pain and weight loss which led to the diagnosis and treatment of a gastrosplenic fistula (GSF) and diffuse large B-cell lymphoma (DLBCL).  The patient later went into remission for his DLBCL but succumbed to respiratory failure from a secondary abdominal-pleural fistula formation. GSFs have the potential to cause fatal massive upper gastrointestinal hemorrhages, infections, fistulas, or obstructions.  Delayed diagnosis corresponds with a higher morbidity and mortality; thus, prompt detection and treatment are imperative.  The management of GSFs is complex due to their rare nature and requires a multidisciplinary approach to care. 

Conclusion: The intention of this report is to provide information and increase awareness of GSFs in the medical community to facilitate their diagnosis.