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Parkash O, Sohail Z, Khalid N. Endoscopic stent placement for the management of gastro-pleural and gastro-cutaneous fistula post laparoscopic sleeve gastrectomy: a case report. J Med Case Rep 2023; 17:461. [PMID: 37926809 PMCID: PMC10626742 DOI: 10.1186/s13256-023-04200-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 10/02/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Gastro-pleural and gastro-cutaneous fistulae formation are rare yet life-threatening complications post-bariatric surgery. To our knowledge so far only limited cases of gastro-pleural and gastro-cutaneous fistulae post gastric sleeve surgery have been reported in the literature with their corresponding management. Therefore, we are reporting a case of placement of an endoscopic stent in the management of gastro-cutaneous fistula post laparoscopic sleeve gastrectomy. CASE PRESENTATION A 42 years old Pakistani, female morbidly obese patient, underwent laparoscopic sleeve gastrectomy. Within a week after the procedure, the patient presented with dyspnea. Workup showed a gastric leak for which percutaneous drain placement was done. Later, gastro-pleural and gastro-cutaneous fistulae were formed for which endoscopic fistula closure was done using a metallic stent. CONCLUSION Endoscopic stent placement is an emerging field and it is considered safe and effective for the management of complications related to bariatric surgery.
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Affiliation(s)
- Om Parkash
- The Aga Khan University Hospital, Karachi, Pakistan
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Koussayer B, Kattih M, Nester M, Peterson P, DuCoin CG. Gastropleural Fistula Presenting as a Complication of Gastric Sleeve Surgery: A Case Report. Cureus 2023; 15:e37133. [PMID: 37162785 PMCID: PMC10163983 DOI: 10.7759/cureus.37133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 05/11/2023] Open
Abstract
A rare complication of sleeve gastrectomy surgery is gastropleural fistulas (GPF), where a fistula develops between the stomach and the pleural cavity. This complication can be debilitating and present with many nonspecific symptoms making it hard to diagnose. This is a case report of a 45-year-old female who underwent robotic-assisted gastric sleeve revision after developing a GPF as a complication of her gastric sleeve six years later. This led to the development of a recurrent subdiaphragmatic abscess in the left upper quadrant. Before presenting to us, she underwent multiple hospitalizations and received numerous endoscopic stent treatments. However, the abscess continued to recur. Given her recurrent abscess, she consented to gastric sleeve revision. GPFs are amongst the rarest complications, with only 76 reported cases. Since this complication can cause shock, early diagnosis and treatment are necessary to improve patient outcomes and reduce morbidity.
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Affiliation(s)
- Bilal Koussayer
- Surgery, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Mafaz Kattih
- Surgery, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Matthew Nester
- Surgery, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Pete Peterson
- Surgery, University of South Florida Morsani College of Medicine, Tampa, USA
- General Surgery, Tampa General Hospital, Tampa, USA
| | - Christopher G DuCoin
- Surgery, University of South Florida Morsani College of Medicine, Tampa, USA
- General Surgery, Tampa General Hospital, Tampa, USA
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Baptiste-Castillo HF, Parra-Zuluaga R, Niño-Andrade F, Rodríguez-Sánchez S. Manejo quirúrgico de una fístula gastropleural posterior a manga gástrica. REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Se presenta el caso de una paciente de 30 años de edad, sometida a un procedimiento de manga gástrica por laparoscopia en marzo de 2014, quien presenta, al tercer y cuarto años del procedimiento inicial, dos episodios de hemoptisis masiva, con falla en la segunda terapia de embolización, por lo que requirió una lobectomía pulmonar inferior izquierda. Al segundo día de este postoperatorio presenta salida de material de nutrición por las sondas de tórax, estableciéndose el diagnóstico de fistula gastro-pleural. Debido a falla con el manejo conservador, fue sometida a una resección quirúrgica de la fístula por vía laparoscópica, con gastrectomía proximal y reconstrucción en Y de Roux. A propósito de nuestra experiencia con esta paciente, se discuten en este artículo las estrategias de manejo para una fístula gastropleural, propuestas en la literatura a la fecha.
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Chan KY, Keogh S, Aucharaz N, Temperley H, O'Driscoll J, Ravi N, Tormey S. Delayed gastropleural fistula: a rare cause of a persistent pleural effusion after blunt force trauma. J Surg Case Rep 2021; 2021:rjab117. [PMID: 33927857 PMCID: PMC8057134 DOI: 10.1093/jscr/rjab117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/10/2021] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Kin Yik Chan
- University Hospital Limerick, Department of Breast and General Surgery, Dooradoyle, Limerick, Ireland
| | - Shane Keogh
- University Hospital Limerick, Department of Breast and General Surgery, Dooradoyle, Limerick, Ireland
| | - Nitin Aucharaz
- University Hospital Limerick, Department of Breast and General Surgery, Dooradoyle, Limerick, Ireland
| | - Hugo Temperley
- St.James's Hospital, Department of General Surgery, D08 NHY1, Dublin, Ireland
| | - James O'Driscoll
- University Hospital Limerick, Department of Anaesthetics and Critical Care, Dooradoyle, Limerick, Ireland
| | - Narayanasamy Ravi
- St.James's Hospital, Department of General Surgery, D08 NHY1, Dublin, Ireland
| | - Shona Tormey
- University Hospital Limerick, Department of Breast and General Surgery, Dooradoyle, Limerick, Ireland
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A Rare Complication of Noncompliance Status Post-Transhiatal Esophagectomy and Esophago-Gastroanastomosis. Case Rep Gastrointest Med 2020; 2020:8833110. [PMID: 33274086 PMCID: PMC7683165 DOI: 10.1155/2020/8833110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/24/2020] [Accepted: 10/28/2020] [Indexed: 12/05/2022] Open
Abstract
Gastropleural fistulas are a complication of peptic ulcers in hiatal hernias, trauma, infections, surgical complications, and malignancy. Presenting symptoms may include gastric and chest pain with respiratory failure in the setting of pneumonitis, hydropneumothorax, or tension pneumothorax. We describe a 57-year-old male with a history of transhiatal esophagectomy and esophago-gastroanastomosis who presented in the setting of dyspnea and dark orogastric tube output. Upper endoscopy revealed multiple gastric ulcers with a dominant ulceration communicating with an adjacent space, and a fistulous tract was demonstrated on computed tomography chest, confirming a gastropleural fistula, a rare life-threatening condition.
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6
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Sakran N, Zakeri R, Madhok B, Graham Y, Parmar C, Mahawar K, Pouwels S. Gastric Fistula in the Chest After Sleeve Gastrectomy: a Systematic Review of Diagnostic and Treatment Options. Obes Surg 2020; 31:357-369. [PMID: 33123868 DOI: 10.1007/s11695-020-05078-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/15/2020] [Accepted: 10/21/2020] [Indexed: 12/31/2022]
Abstract
This study aimed to establish the optimal diagnostic and treatment algorithm for the management of gastric fistula in the chest (GFIC) after sleeve gastrectomy (SG) through a systematic review of published cases. A multi-database search was performed, which produced 1182 results, of which 26 studies were included in this systematic review. The initial presentation included subphrenic collections, leaks, or (recurrent) pneumonia with associated symptoms such as persistent cough, fever, and/or dyspnea. Computed tomography (CT) scan in combination with either upper gastrointestinal (UGI) series or an esophagogastroduodenoscopy (EGD) was used to adequately diagnose the fistulas. Initial treatment was either with clips and/or clips and stents that were placed endoscopically. When unsuccessful in the majority of the cases, the surgical treatment consisted of total gastrectomy and Roux-en-Y esophagojejunostomy in a laparoscopic or open fashion.
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Affiliation(s)
- Nasser Sakran
- Department of Surgery, Emek Medical Center, 21 Izhak Rabin Blvd, 1834111, Afula, Israel. .,The Technion - Israel Institute of Technology, Haifa, Israel.
| | - Roxanna Zakeri
- Department of Surgery, University College London Hospital NHS Foundation Trust, London, UK
| | - Brijesh Madhok
- University Hospital of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Yitka Graham
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK.,Facultad de Psucologia, Universidad Anahuac Mexico, Mexico City, Mexico.,Bariatric Unit, South Tyneside and Sunderland NHS Trust, Sunderland, UK
| | | | - Kamal Mahawar
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK.,Bariatric Unit, South Tyneside and Sunderland NHS Trust, Sunderland, UK
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
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Sobhani Z, Moein Vaziri N, Hosseini B, Amini M, Setoodeh M, Karimi A. Late Gastropleural Fistula after the Management of Laparoscopic Sleeve Gastrectomy Leakage. Obes Surg 2020; 30:3620-3623. [PMID: 32300947 DOI: 10.1007/s11695-020-04604-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
One of the rare but serious complications of laparoscopic sleeve gastrectomy (LSG) with significant morbidity and mortality is gastropleural fistula (GPF). Here, we present a 34-year-old woman who underwent LSG. Due to leakage in the proximal site of the stapler line and splenic artery erosion into the site of leakage after 1 month, splenectomy and drainage catheter insertion was done. Three months later, she presented with dyspnea, fever, and lung abscess, GPF was diagnosed, and Roux-en-Y fistulo-jejunostomy was done. After 10 days, her clinical condition improved, but the patient expired due to hemorrhagic cerebrovascular accident (CVA). Therefore, GPF along with other common complications should be seriously considered in patients developing post-LSG chronic respiratory symptoms.
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Affiliation(s)
- Zahra Sobhani
- Laparoscopy research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nader Moein Vaziri
- Department of Surgery, School of Medicine, Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Babak Hosseini
- Department of Surgery, School of Medicine, Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masood Amini
- Department of Surgery, School of Medicine, Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. .,Laparascopy Research Center, Mother and Child Hospital Ghadir, Above gate Quran, First Town Gulshan, Shiraz, Iran.
| | - Maryam Setoodeh
- Obesity Prevention and Treatment Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Karimi
- Department of Surgery, School of Medicine, Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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