Case report-complex management of a postoperative bronchogastric fistula after laparoscopic sleeve gastrectomy.
Laparoscopic sleeve gastrectomy (LSG) is a new restrictive bariatric procedure increasingly indicated in the treatment of morbid obesity. Postoperative complications are mainly represented by gastric fistula with an occurrence rate of 0% to 5.1% in the literature. This complication is difficult to manage and requires multiple radiological, endoscopic, and surgical procedures. We report herein the case of a 23-year-old woman who underwent LSG for morbid obesity. This patient was reoperated for peritonitis due to a gastric fistula located on the top of the staple line. Five months later, she complained of a cough with fever and expectoration. A methylene blue test and a computed tomography scan diagnosed a postoperative bronchogastric fistula. After failure of aggressive conservative management, radical surgery was performed with total gastrectomy, reconstruction of the diaphragm using the extended latissimus dorsi flap, and a pulmonary lobectomy. This case report highlights the possible issue of the complex management of gastric fistula after LSG.
Fuks
David
D
Department of Digestive Surgery, Amiens North Hospital, University of Picardy, place Victor Pauchet, 80054, Amiens, France.
Dumont
Frederic
F
Department of Digestive Surgery, Amiens North Hospital, University of Picardy, place Victor Pauchet, 80054, Amiens, France.
Berna
Pascal
P
Department of Thoracic Surgery, Amiens North Hospital, University of Picardy, place Victor Pauchet, 80054, Amiens, France.
Verhaeghe
Pierre
P
Department of Digestive Surgery, Amiens North Hospital, University of Picardy, place Victor Pauchet, 80054, Amiens, France.
Sinna
Raphael
R
Department of Plastic Surgery, Amiens North Hospital, University of Picardy, place Victor Pauchet, 80054, Amiens, France.
Sabbagh
Charles
C
Department of Digestive Surgery, Amiens North Hospital, University of Picardy, place Victor Pauchet, 80054, Amiens, France.
Demuynck
Fabien
F
Department of Radiology, Amiens North Hospital, University of Picardy, place Victor Pauchet, 80054, Amiens, France.
Yzet
Thierry
T
Department of Radiology, Amiens North Hospital, University of Picardy, place Victor Pauchet, 80054, Amiens, France.
Delcenserie
Richard
R
Department of Gastroenterology, Amiens North Hospital, University of Picardy, place Victor Pauchet, 80054, Amiens, France.
Bartoli
Eric
E
Department of Gastroenterology, Amiens North Hospital, University of Picardy, place Victor Pauchet, 80054, Amiens, France.
Regimbeau
Jean-Marc
JM
Department of Digestive Surgery, Amiens North Hospital, University of Picardy, place Victor Pauchet, 80054, Amiens, France. regimbeau.jean-marc@chu-amiens.fr.
D050110:Bariatric Surgery / Q000009:adverse effects* / Q000379:methods; D001983:Bronchial Fistula / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D004396:Coloring Agents; D003287:Contrast Media; D003964:Diaphragm / Q000601:surgery; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D005747:Gastric Fistula / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008168:Lung / Q000601:surgery; D008751:Methylene Blue; D009767:Obesity, Morbid / Q000601:surgery; D012086:Reoperation; D014057:Tomography, X-Ray Computed; D055815:Young Adult
D004396:Coloring Agents; D003287:Contrast Media; D008751:Methylene Blue