Percutaneous embolization for a subacute gastric fistula following laparoscopic sleeve gastrectomy: a case report and li
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CASE REPORT
Open Access
Percutaneous embolization for a subacute gastric fistula following laparoscopic sleeve gastrectomy: a case report and literature review Hung-Hsuan Yen1,2, Yu-Ting Lin2, Jin-Ming Wu1,2, Kao-Lang Liu3 and Ming-Tsan Lin2*
Abstract Background: The management for subacute or chronic fistula after bariatric surgery is very complicated and with no standard protocol yet. It is also an Achilles’ heel of all bariatric surgery. The aim of this case report is to describe our experience in managing this complication by percutaneous embolization, a less commonly used method. Case presentation: A 23-year-old woman with a body mass index of 35.7 kg/m2 presented with delayed gastric leak 7 days after laparoscopic sleeve gastrectomy (LSG) for weight reduction. Persistent leak was still noted under the status of nil per os, nasogastric decompression, and parenteral nutrition for 1 month; therefore, endoscopic glue injection was performed. The fistula tract did not seal off, and the size of pseudocavity enlarged after gas inflation during endoscopic intervention. Subsequently, we successfully managed this subacute gastric fistula via percutaneous fistula tract embolization (PFTE) with removal of the external drain 2 months after LSG. Conclusions: PFTE can serve as one of the non-invasive methods to treat subacute gastric fistula after LSG. The usage of fluoroscopy-visible glue for embolization can seal the fistula tract precisely and avoid the negative impact from gas inflation during endoscopic intervention. Keywords: Fistula, Leak, Sleeve gastrectomy, Bariatric surgery, Embolization
Background The risk of leak after laparoscopic sleeve gastrectomy (LSG) was 2.4, and 89% of leak occurred at the proximal third of the stomach [1]. Most leaks result from the disruption of blood supply around the angle of His combined with increased intraluminal pressure and decreased gastric tube compliance after LSG [2]. Relaparoscopy or even re-laparotomy is necessary for leak happening within 24 to 48 h after primary bariatric surgery or anytime when uncontrolled septic signs develop * Correspondence: [email protected] 2 Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan Full list of author information is available at the end of the article
and persist; otherwise, a non-operative management is suggested by most bariatric surgeons [3]. The management for subacute or chronic leak after bariatric surgery with fistula tract formation is more complicated, with no standard protocol yet, and also an Achilles’ heel of all bariatric surgery [4–9].
Case presentation The 23-year-old woman with the body mass index (BMI) of 35.7 kg/m2 was evaluated for LSG. Her past medical history was significant for bilateral knee osteoarthritis and had taken over-the-counter pain relievers for a long time with suboptimal effects. The blood tests from her primary care physician denoted prediabetes,
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which
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