Computed tomography-guided percutaneous gastrostomy for management of gastric remnant leak after Roux-en-Y gastric bypass

Karmali, Shahzeer; Azer, Nader; Sherman, Vadim; Birch, Daniel W.

doi:10.1016/j.soard.2010.02.042

Cited by 4 publications

(2 citation statements)

References 11 publications

(23 reference statements)

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“…Our patient's gastric remnant leak was identified only after contrast delivery through the gastrostomy tube; previous diagnostic studies, including ultrasound, CT scans with and without contrast, MRCP, ERCP, upper GI fluoroscopy, and small bowel enteroscopy were all non-diagnostic. Similar diagnostic difficulty was described in another case of gastric remnant leak also complicated by the formation of amylasecontaining dark ascitic fluid, in which the correct diagnosis was made only with CTguided percutaneous gastrostomy followed by administration of contrast material (5). We hypothesize that this diagnostic difficulty is due to the inability of enteral contrast to reach the decompressed gastric remnant in adequate volume to detect a perforation, since it would be required to move against the typical flow of gastric secretions after a Roux-en-Y procedure.…”

Section: Discussionsupporting

confidence: 54%

“…Most leaks (between 69% and 77%) occur at the gastrojejunal anastomosis, and on average, they become symptomatic three days after surgery (3,4). Rare leaks from the gastric remnant, which is the larger portion of the stomach that during a Rouxen-Y surgery is bypassed with the gastrojejunal anastomosis, have been reported and have been said to have delayed presentations, though this has typically only been weeks after surgery, not years (1,5). This is a case of post-Roux-en-Y gastric remnant leak that occurred 15 years after the original surgery, underscoring the importance of considering post-surgical leak as a diagnostic possibility regardless of how remotely a Roux-en-Y surgery took place.…”

Section: Introductionmentioning

confidence: 99%

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A Case and Brief Review of Bilious Ascites and Abdominal Compartment Syndrome from Pancreatitis-Induced Post-Roux-En-Y Gastric Remnant Leak

Martin¹,

Lee²,

Neumeier³

et al. 2021

Southwest J Pulm Crit Care

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This is a case of a 55-year-old man with Roux-en-Y gastric bypass surgery 15 years prior who presented with acute pancreatitis and developed distributive shock, bacteremia, acute respiratory distress syndrome, anuric acute renal failure, and a distended abdomen with increasing ascitic fluid on imaging. An elevated bladder pressure, lactic acidosis, and anuria raised concern for abdominal compartment syndrome. Paracentesis was done and four liters of bilious ascitic fluid were drained. Intra-abdominal pressure was measured and improved from 27 cmH2O to 13 cmH2O with paracentesis. Mean arterial pressure and urine output also improved. The patient developed recurrent loculated intra-abdominal fluid collections, though ultrasound, CT scans with and without contrast, MRCP, ERCP, upper GI fluoroscopy, and small bowel enteroscopy failed to reveal a source of the bilious output. Ultimately, a gastrostomy tube was placed and delivery of contrast material through the tube revealed active extravasation from the remnant stomach. This case underscores the importance of considering post-surgical leak regardless of how remotely a Roux-en-Y surgery took place, confirms the importance of pursuing early gastrostomy tube placement and contrast administration when post-Roux-en-Y gastric remnant leaks are suspected, and demonstrates the role of paracentesis in critically ill patients with abdominal compartment syndrome.

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Section: Discussionsupporting

confidence: 54%