title: Development of a gastric pouch-aorto-colic fistula as a complication of a revisionary open roux-en-y gastric bypass.
abstract: A 45-year-old female presented with an enterocutaneous fistula and intraabdominal abscesses weeks after undergoing an open roux-en-y gastric bypass 20 years after a previous bariatric procedure. Initial management consisted of exploration with resection of the fistula, open abscess drainage, percutaneous drains, and culture-directed intravenous antibiotics. Months later, the patient developed a gastrocolic fistula and massive upper gastrointestinal bleeding from a gastro-aortic fistula. The patient underwent resection of the gastrocolic fistula followed by a damage control operation including a left thoracotomy with aortic cross-clamping for the gastro-aortic fistula. Final reconstruction necessitated an extra-anatomic opening in the diaphragm for creation of an intrathoracic esophagojejunostomy and marsupialization of the distal esophagus and gastric pouch with concomitant mucusectomy. This rare but devastating complication requires prompt surgical management. In the appropriate setting, a high suspicion must be maintained in order to act swiftly for the patient's benefit.
authors.affiliation: Department of General Surgery, William Beaumont Hospital, 3601 West Thirteen Mile Road, Royal Oak, MI, 48073, USA.
authors.forename: Mario Raul
authors.initials: MR
authors.lastname: Villalba
authors.affiliation: Department of General Surgery, William Beaumont Hospital, 3601 West Thirteen Mile Road, Royal Oak, MI, 48073, USA. mario.villalba@beamont.edu.|Surgical Critical Care, William Beaumont Hospital, 3601 West Thirteen Mile Road, Royal Oak, MI, 48073, USA. mario.villalba@beamont.edu.|, 3535 W. 13 Mile Rd., Suite 501 Medical Office Building, Royal Oak, MI, 48073, USA. mario.villalba@beamont.edu.
authors.forename: Mario Ramon
authors.initials: MR
authors.lastname: Villalba
mesh_terms: D018784:Abdominal Abscess / Q000209:etiology; D001018:Aortic Diseases / Q000209:etiology* / Q000601:surgery; D003108:Colonic Diseases / Q000209:etiology* / Q000601:surgery; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D005747:Gastric Fistula / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology* / Q000601:surgery; D008875:Middle Aged; D012086:Reoperation / Q000009:adverse effects