Gastrobronchial fistula post laparoscopic sleeve gastrectomy in immunocompromised patient

Abstract

Bariatric surgery is evolving worldwide nowadays. Postoperative complications are mainly represented by gastric leak reported range between 1% to 3.3%. The worse scenario of the leak post laparoscopic sleeve gastrectomy is a fistula. Many types of fistula were prescribed and one of the theses is gastrobronchial one. It has a catastrophic sequela if not diagnosed and treated efficiently early. It is difficult to manage either radiologically, endoscopically or surgically. No clear consensus yet for the standard of treatment for such complication especially if these patients are immunocompromised was the mortality will be very high. Therefore, we aim to contribute our successful approach to treating our patient. We report a case of a 27-year-old female who is obese with systemic lupus erythematous controlled medically underwent laparoscopic sleeve gastrectomy. 6 months later she presented to the hospital with productive cough post-operative stenting and esophageal dilation was performed. 15 months post LSG patient presented with productive cough with green sputum, food particle, and left-sided chest pain. Endoscopic clip placement was attempted with no avail. The management of gastrobronchial fistulas involves a comprehensive clinical evaluation. In the absence of red flags, initial conservative management should be undertaken. When all else fail, surgery is the only route towards a permanent and definitive treatment. The need for further research and consensus is of utmost importance to guide future surgeons and to increase awareness among the medical community, due to its presentation under the facade of common symptoms.