Gastropleural Fistula: A Rare Complication of a Common Procedure

Abstract

Weight loss surgeries are evident to be highly beneficial in patients with morbid obesity (body mass index (BMI) ≥40.0 kg/m 2 ) and severe obesity (BMI between 35.0 and 39.9 kg/m 2 with co-morbidities). While this results in significant mortality benefit, there is always the possible risk of postsurgical complications. Gastrobronchial and gastropleural fistulas are two rare, post-operative pulmonary complications associated with these surgeries. Our patient is a 54-year-old female who underwent a biliopancreatic diversion with a duodenal switch. A few weeks later, she started developing a cough, fever, and shortness of breath. Computed tomography (CT) chest showed the presence of a loculated right sided hydropneumothorax. A gastrointestinal fluoroscopic contrast study performed showed a large fistula originating from the distal end of the stomach and ending towards the right pleural cavity. The fistula was successfully closed with the endoscopic fulguration of fistulous opening with argon beam coagulation and orthoscopic clipping, resulting in complete obliteration of the fistula tract. The right-sided hydropneumothorax was initially treated conservatively with antibiotics and chest tube drains followed by video-assisted thoracoscopic decortication with chest tube placement. Gastropleural fistula formation is rare but is nonetheless a serious postoperative complication of bariatric procedures and mimics pneumonia clinically. It is, therefore, essential to obtain detailed imaging work-up to rule out fistula formation, which, in turn, can be timely treated without causing further devastating results to the patient.

The rare thoracic complication: perforation of gastric fundus ulcer: a case report

“…Although, radical surgery may be preferable for suspected malignancy, it should be weighed carefully against the risk of sepsis and the morbidity associated with a prolonged procedure in a sick patient [ 6 , 7 ]. If the risk of bleeding and infection has been reduced, damage-control surgery may be an acceptable alternative in severely ill patients, with more extensive resection reserved for later [ 3 ].…”

A Rare Complication of Noncompliance Status Post-Transhiatal Esophagectomy and Esophago-Gastroanastomosis

“…First described in 1960 by Markowtts and Herter, GPF can be an acquired complication from peptic ulcerations via hiatal hernia, trauma, and perforation with abscess formation [ 1 ]. Case reports have described oral intake of steroids or anti-inflammatory drugs increasing the risk of gastric perforations, and several studies have demonstrated that GPF can also be a serious complication from surgical interventions and malignancy [ 2 – 6 ]. As the diaphragm acts as an effective barrier, communicating fistulas from the stomach and pleural space through the diaphragm are extremely rare.…”

Endoscopic stent placement for the management of gastro-pleural and gastro-cutaneous fistula post laparoscopic sleeve gastrectomy: a case report

“…This mechanism produces necrosis of the gastric remnant, resulting in the development of a leak which leads to the formation of an inflammatory phlegmon. The inflammatory phlegmon from the contained leak subsequently eroded through the diaphragm, setting up an inflammatory process resulting in fistulation [ 7 , 8 ]. Also post LSG, a high-pressure system of a sleeved stomach from an intact pylorus distally and lower esophageal sphincter proximally, increases the risk of persistent leaks or fistulation to adjacent anatomical compartments.…”