Fatal aortoesophageal fistula bleeding after stenting for a leak post sleeve gastrectomy

Abstract

Bariatric surgeries have been used in an effort to curtail the obesity epidemic. The type of surgery used has changed over time, with sleeve gastrectomies being one of the preferred options. This has been associated with some complications, including staple line leaks. We report a 43-year old female who had undergone a laparoscopic sleeve gastrectomy that was complicated by a proximal gastric pouch leak at the gastroesophageal junction. We used self-expandable stents (SEMS) in the management of the leak. Seven weeks after the insertion of the initial SEMS, the patient presented with a massive gastrointestinal bleed that could not be localized due to profuse bleeding. The patient underwent a computerized tomography angiogram and then an angiogram that could not localize the site of the bleed. An emergency laparotomy was performed and identified the source of bleeding to be an aortoesophageal fistula. A graft of the diseased area was attempted but the patient unfortunately did not survive the procedure. An aortoesophageal fistula after an esophageal SEMS insertion for a benign disease has rarely been reported and only in cases where there was a thoracic neoplasm, thoracic aortic aneurism, endovascular stent repair, foreign body or esophageal surgery. To our knowledge, this is the first case that reports an aortoesophageal fistula as a result of a SEMS for the management of a gastric pouch leak after a laparoscopic sleeve gastrectomy.© 2013 Baishideng Publishing Group Co., Limited. All rights reserved.Key words: Stents; Esophagus; Leak; Surgery; Complication; Aortoesophageal fistula; Endoscopy; Bariatric surgery; Sleeve gastrectomy Core tip: One modality for managing staple line leaks after laparoscopic sleeve gastrectomies depends on a non-surgical approach, including elimination of oral intake, parenteral nutrition, use of broad spectrum antimicrobial therapy, drainage procedures and the use of esophageal self-expandable metal stents for sealing these leaks and the induction of tissue hyperplasia that would close these defects. Although this seems as a less invasive procedure when compared to a repeated surgical procedure and there is a body of evidence in the literature that supports such an approach, it is not void of complications. Here we report a fatal aortoesophageal fistula as a complication.Almadi MS, Bamihriz F, Aljebreen AM. Fatal aortoesophageal fistula bleeding after stenting for a leak post sleeve gastrectomy.

An Assessment of the Optimal Time for Removal of Esophageal Stents Used in the Treatment of an Esophageal Anastomotic Leak or Perforation

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Endoscopic treatment of the fistulas after laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass

“…There is no consensus in the literature as to the time for prosthesis removal. Published papers report a period between four and eight weeks 20,24 . In our series, the average time of prosthesis stay was 9.4 weeks.…”

Aorto-oesophageal fistula after oesophageal stent placement in a patient with a Roux-en-Y gastric bypass

“…However, none of these patients underwent RYGB. To our knowledge, there is one similar case where the patient underwent gastric sleeve 4 and one case where a patient developed an aortogastric fistula after implantation of the same type of stent as we used in this case. …”