Delayed Intra Splenic Abscess: a Specific Complication Following Laparoscopic Sleeve Gastrectomy

Gastrosplenic Fistula and/or Splenic Abscess: A Rare and Refractory Complication Following Sleeve Gastrectomy

Splenic abscess is a rare complication often associated with sleeve gastrectomy (SG) due to factors including local infections, distant infections, tumors, ischemia, and trauma, which presents substantial challenges. We report four cases of gastrosplenic fistula and/or splenic abscess after SG. Patient data, including demographics, comorbidities, diagnostic procedures, treatments, and outcomes, were recorded. Surgical techniques for SG adhered to established protocols. Four patients had a male-to-female ratio of 2:2, with an average age of 39.8 years and an average preoperative BMI of 38.9 kg/m2. All patients were readmitted due to recurrent fever and chills caused by splenic abscesses detected on CT scans, with an average admission duration of 16.5 weeks. Treatments varied from fasting and antibiotics to percutaneous drainage and surgical interventions. The average treatment duration post-diagnosis of splenic abscess was 37.25 weeks. Managing gastrosplenic fistula and/or splenic abscess is complex, underscoring the significance of prompt diagnosis and proper treatment. This highlights the need for heightened awareness among healthcare professionals to promptly recognize and manage this rare complication after SG.

Diffuse Peritonitis Caused by Splenic Abscess After Laparoscopic Sleeve Gastrectomy: A Case Report

A splenic abscess (SA) following sleeve gastrectomy (SG) is a rare manifestation of a gastric leak (GL). The clinical findings include fever, abdominal pain, leukocytosis, and an elevated C-reactive protein. A computed tomography scan is diagnostic and can show signs of GL, or diffuse peritonitis. Treatment can either be non-operative (including large-spectrum antibiotics and percutaneous drainage) or surgical (including splenectomy). We present the case of a 41-year-old female patient with SA, with septic shock and diffuse peritonitis, successfully treated with a splenectomy three months post-SG.

Post-laparoscopic sleeve gastrectomy with splenic abscess: Case report

INTRODUCTION AND IMPORTANCE

One of the complications of laparoscopic sleeve gastrectomy (LSG) is a splenic abscess, considered a rare complication. As it is rare, it is a challenge to diagnose.

CASE PRESENTATION

In this case, a 62-year-old male patient who underwent LSG returned after three weeks with abdominal pain and fever. CLINICAL DISCUSSION: leak, Infection, spleen infarction These seemed like common complications, such as leaking from the stapler line, but the CT findings indicated a splenic abscess. The primary explanation for such an abscess is unclear in our case as the other reported cases were with the hypothesis of the late leak. A different treatment approach, laparoscopic exploration with incision and drainage, is the preferred option for this patient.

CONCLUSION

rare complications can be a challenge and how to manage them can be different from the standard to help the patient.

Post-Bariatric Splenic Complications; Diagnosis and Treatment. A Systematic Review

This systematic review intends to evaluate incidence and symptoms of post-bariatric splenic complications as well as best available modalities establishing the diagnosis and management protocols. A systematic literature search was performed in electronic database until March 2022. A total of 41 articles were included on the subject of splenic complications following bariatric/metabolic surgery (BMS). Splenic abscess was the most common splenic complications (44.2%) after BMS and leak was the most common reported etiology of the splenic abscess. Fever and abdominal pain were the most common presenting symptom in all splenic complications and CT scan was the most common diagnostic modality. Splenic complications after BMS are relatively rare but may lead to dangerous consequences. Prompt diagnosis and treatment can prevent potentially life-threatening outcomes.

Imaging after laparoscopic sleeve gastrectomy - literature review with practical recommendations

In the XXI century obesity has become one of the most demanding epidemiological threats worldwide. At the same time, bariatric surgery has established itself as an effective treatment for morbidly obese patients, with laparoscopic sleeve gastrectomy (LSG) emerging as the most popular bariatric procedure. This paper reviews the role of imaging studies of patients after LSG. Computed tomography is widely considered as the method of choice in detection of complications in early postoperative period. The dynamic character of upper gastrointestinal examination allows for the assessment of passage through the gastric remnant. The paper also discusses evaluation of the shape and volume of the gastric remnant assessed by imaging studies.

Splenic abscess after laparoscopic sleeve gastrectomy. A rare complication-case report and literature review

Laparoscopic sleeve gastrectomy is currently a stand-alone bariatric procedure with a low complication profile. A rare complication of leak following sleeve gastrectomy was reported in this study. Its rareness and nonspecific clinical presentation could make the diagnosis difficult and could be easily confused with leak and subdiaphragmatic abscess. A 22-year-old Saudi female with body mass index 41 underwent laparoscopic sleeve gastrectomy in 2017, presented 18 months later to emergency department complaining of fever and abdominal pain for 3 months prior to presentation. Computed tomography of abdomen revealed a large splenic abscess, upper gastrointestinal studies were unremarkable. Patient was taken for laparoscopic exploration with finding of splenic abscess and gastric fistula, splenectomy and clipping of fistula was performed. The management of splenic abscess remains controversial. Splenectomy and antibiotics have generally been the definitive treatment particularly with large multilobulated collection. Familiarity with the rare complications as splenic abscess will allow for a prompt diagnosis and treatment.

Splenic Abscess Following Sleeve Gastrectomy: A Systematic Review of Clinical Presentation and Management Methods

BACKGROUND

Splenic abscess is a rare complication following sleeve gastrectomy.

METHODS

We performed a systematic review to clarify its clinical significance, presentation, and management. PubMed, Embase, MEDLINE, Google Scholar, and the Cochrane Library were searched up to the 19th of July 2020. A total of 18 patients were included, of which 11 were female and 7 were male. The mean age was 34.1 ± 12.3 years, and the mean body mass index was 45.8 ± 7.6 kg/m². Type 2 diabetes mellitus was reported in 11.1% of patients and hypertension in 22.2%. Fever was the most common presenting symptom seen in 17 (94.4%) patients, followed by abdominal pain in 10 (55.6%). The mean duration from surgery to presentation was 98.6 ± 132.7 days (range 10-547 days). Computed tomography was used for investigations in 17/18 (94.4%) patients. Seven patients had reported leak, three reported bleeding, and 2 reported pleural effusion. Thirteen patients had unilocular abscess. All patients were treated with antibiotics. Four patients needed total parenteral nutrition, and three were given proton pump inhibitor. In total, 11 patients needed percutaneous drainage as a part of treatment and 11 patients needed total splenectomy and 1 needed partial splenectomy.

CONCLUSION

Splenic abscess following sleeve gastrectomy is a rare identity. The etiology of formation of splenic abscess needs further studies. A computed tomography of the abdomen with contrast is the preferred diagnostic tool. There is no gold standard treatment for splenic abscess.

Splenic Abscess Complicating Bariatric Surgery : A Systematic Review

INTRODUCTION

Bariatric surgery has become one of the most rapidly growing subspecialty performed globally, and it has been well reported to be associated with low morbidity and mortality rates. Splenic abscess is a rare but serious complication of bariatric surgery that has not been previously systematically reviewed in the literature.

METHODS

The authors have performed a systematic review of the evidence that has looked into the pathophysiology, clinical presentation, and the management options of splenic abscess complicating bariatric surgery.

RESULTS

This systematic review has been unsurprisingly based on level-IV evidence due to the rarity of the explored condition. The final analysis included 27 relevant reported cases. The mean age was 38 years and the mean of the time interval between the initial operation and developing splenic abscess was 72 days, with the male to female ratio being 1:1.6. Laparoscopic sleeve gastrectomy was the initial operation in 85.2% of the patients. Nearly half of the patients did not have an objective evidence of local or systemic sepsis that could explain the abscess formation. Nonsurgical management was attempted in 14 patients, with 34% success rate only. Splenectomy was needed in 41.7% of the patients. No mortality was reported.

CONCLUSIONS

Splenic abscess is a rare and rather late but serious complication of bariatric surgery that could result in splenectomy in a relatively young group of patients. It is more commonly reported following laparoscopic sleeve gastrectomy. Early diagnosis with intervention in a timely manner is crucial to avoid life threatening complications.

Splenic Abscess after Sleeve Gastrectomy

Splenic abscess is a very rare complication of laparoscopic sleeve gastrectomy (LSG). Clinical presentation includes fever, leucocystosis, and abdominal pain. CT SCAN is a must for diagnosis. The preferred treatment is either conservative, with intravenous antibiotics and percutaneous drainage, or splenectomy. We report the thirteen case of a splenic abscess after LSG. In our patient, the abscess occurred three weeks after LSG in a 21-year-old man, and it was successfully treated conservatively.

Splenectomy fails to attenuate immuno-hematologic changes after rodent vertical sleeve gastrectomy

Bariatric surgery is on the rise for long-term weight loss and produces various positive metabolic health benefits. The mechanisms that produce surgical weight loss are not yet fully understood. Previous studies showed vertical sleeve gastrectomy prior to gestation resulted in reduced peripheral blood lymphocytes measured during pregnancy due to an undetermined etiology. Further, elevated splenic weight has been associated with vertical sleeve gastrectomy surgery. We hypothesized that perhaps altered splenic filtration was trapping circulating lymphocytes and thus reducing peripheral blood lymphocytes in circulation and contributing to increased spleen weight. We posited whether removal of the spleen concomitant with the stomach surgery may result in an improved immune phenotype. We evaluated female long Evans rats having received Sham surgery or vertical sleeve gastrectomy, with or without splenectomy to determine the contribution of the spleen on metabolic and immune factors after vertical sleeve gastrectomy. Vertical sleeve gastrectomy animals lost significant amounts of body mass and fat mass and ate less in comparison to Sham females during the first five post-operative weeks, but there was no specific effect of the loss of spleen on body mass, fat mass, or food intake. During the post-operative week 6, animals were euthanized and blood recovered for cell sorting of immune cells. There was a reduction in CD3+ total T cells, CD3/CD4+ helper T cells, and CD3/CD8+ cytotoxic T cells, main effect of both bariatric surgery (P  < 0.0001) and splenectomy (P  < 0.01). Furthermore, there was a significant increase in CD45RA+ B cells as a result of splenectomy (P  < 0.001), but a significant reduction in B cells as a result of VSG surgery (P  < 0.05). The changes in total T cells but not B cells were strongly correlated with fat mass. Further studies are needed to understand the cause of the immune changes after surgical weight loss.