Laparoscopic Gastropleural Fistula Repair: A Minimally Invasive Solution for a Complex Problem

Gastropleural Fistula in a Child with Acute Lymphoblastic Leukemia Due to Perforated Gastric Ulcer

Gastropleural fistula (GPF) is a pathological communication between stomach and pleural cavity. GPF is described rarely in adults following bariatric surgery, iatrogenic perforations, complicated empyema thoracis, penetrating chest trauma, perforated malignant gastric ulcers, and invasive tumors. GPF in children is extremely rare. The authors describe a female child with leukemia, who presented with left-sided pneumonia and chylothorax. After a delay of around 3 wk she was diagnosed with GPF, which was due to a perforated gastric ulcer induced by high-dose steroids which she was receiving as chemotherapy. She was managed with repair of GPF and had a favorable outcome.

Delayed gastropleural fistula: a rare cause of a persistent pleural effusion after blunt force trauma

A gastropleural fistula (GPF) is a rare pathological connection between the stomach and pleural cavity. Diagnosis and treatment are frequently delayed due to the lack of specific clinical, laboratory and radiological findings. We describe a case of a 53-year-old gentleman who presented to our institution with respiratory sepsis and a massive haemopneumothorax on imaging. Uniquely, he was discharged a week prior after a splenectomy for a traumatic fall. Gut flora in the pleural fluid and a subsequent positive dye test suggested an aero-digestive connection. Repeat imaging revealed a fistula between stomach and the left pleural cavity through a ruptured diaphragm. He underwent an open sleeve gastrectomy and primary repair of the diaphragm. This is the first GPF in literature presenting in such a fashion. Although rare, a persistent effusion with a history of blunt thoracoabdominal trauma may herald a GPF, which, if not diagnosed promptly, may result in significant morbidity.

Empyema Caused by Gastropleural Fistula Post Complicated Laparoscopic Sleeve Gastrectomy

Gastropleural fistula (GPF) can occur as a rare complication of laparoscopic sleeve gastrectomy (LSG). Here, we present the clinical presentation, radiological findings, and outcome of a 19-year-old female who underwent LGS in Mother and Child Hospital in Shiraz, Iran, but due to leakage in the proximal of the stapler line, the operation converted to a single anastomosis sleeve ileal (SASI) bypass to decrease intraluminal pressure and accelerate healing of leakage site. Three months later, the patient admitted with the impression of empyema and diagnosed finally with a GPF. Although the conversion of LSG to SASI bypass for post leakage may be efficient in controlling the intraabdominal leakage, it will not prevent GPF formation, so applying another surgery method such as classic bypass in this situation may be more effective in the management of stapler line leakage.