Empyema Caused by Gastropleural Fistula Post Complicated Laparoscopic Sleeve Gastrectomy
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Empyema Caused by Gastropleural Fistula Post Complicated Laparoscopic Sleeve Gastrectomy Zahra Sobhani 1 & Babak Hosseini 2 & Nader MoeinVaziri 2 & Ebrahim Kheradmand 2 & Masood Amini 2,3 Maryam Setoodeh 4
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Received: 29 August 2020 / Revised: 12 September 2020 / Accepted: 15 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract 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. Keywords Empyema . Gastropleural fistula . Laparoscopic sleeve gastrectomy
Introduction Laparoscopic sleeve gastrectomy (LSG) is a restrictive bariatric procedure for treating obesity disorder by removing about 85% of the stomach [1]. Even though LSG is relatively a safe option for losing weight, some complications have been reported such as leakage, bleeding, infection, and strictures. Staple line leakage is the most common problem among them [2]. A gastric leak is an effluent of gastric content through a suture line, which may collect near the suture line or exit through the drain [3]. In most patients, a gastric leak develops in less than 14 days after the bariatric surgery
[4]. Patients may be asymptomatic or present with signs and symptoms of septic shock accompanied by abdominal pain, fever, and tachycardia [3]. Based on the time of diagnosis, the gastric leaks are classified into early or delayed leaks. An early leak is generally diagnosed within the first 3 days after surgery, while a delayed leak is usually diagnosed over 8 postoperative days [4]. Gastropleural fistula (GPF) can occur as a rare and lifethreatening complication of LSG [5, 6]. Considering the rarity of GPFs, this case report outlines the clinical presentation, radiological findings, and outcome of a 19-year-old female who presented with empyema 3 months post complicated LSG and diagnosed finally with a GPF.
* Masood Amini [email protected]
Maryam Setoodeh [email protected]
Zahra Sobhani [email protected]
1
Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Babak Hosseini [email protected]
2
Department of Surgery, School of Medicine, Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Nader MoeinVaziri nmv
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