Alkhatib Suehyb G, Levine Marc S
Department of Radiology, Pennsylvania Hospital, Philadelphia, PA 19107, United States of America.
Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, United States of America.
Clin Imaging. 2019 Jan-Feb;53:112-114. doi: 10.1016/j.clinimag.2018.10.009. Epub 2018 Oct 6.
We describe a patient who developed an intractable leak from the gastric sleeve after laparoscopic sleeve gastrectomy, resulting in the development of a gastrobronchial fistula. Affected individuals typically have a persistent leak from the gastric sleeve with recurrent subphrenic abscesses, and when a gastrobronchial fistula develops, these patients may present with paroxysms of coughing immediately after ingestion of solids or liquids. In the appropriate clinical setting, a barium study not only may show the leak, but also directly visualize the gastrobronchial fistula. If aggressive endoscopic dilation procedures and/or endoscopic placement of stents or clips fail to facilitate healing of the leak and fistula, these patients may require surgical intervention, with conversion of the sleeve to a Roux-en-Y gastric bypass or even a partial or total gastrectomy. The development of a gastrobronchial fistula after sleeve gastrectomy therefore can be extremely challenging to manage.
我们描述了一名患者，该患者在腹腔镜袖状胃切除术后出现胃袖状部顽固性渗漏，进而导致胃支气管瘘的形成。受影响的个体通常胃袖状部持续渗漏，并伴有复发性膈下脓肿，当胃支气管瘘形成时，这些患者在摄入固体或液体后可能立即出现阵发性咳嗽。在适当的临床情况下，钡剂造影不仅可以显示渗漏，还能直接观察到胃支气管瘘。如果积极的内镜扩张手术和/或内镜下放置支架或夹子未能促进渗漏和瘘管的愈合，这些患者可能需要手术干预，将袖状胃转换为 Roux-en-Y 胃旁路术，甚至进行部分或全胃切除术。因此，袖状胃切除术后胃支气管瘘的处理极具挑战性。
