Breakeit Sarah A, Gheshayan Sultanah, Alamri Bader A, Albalwi Emad F, Alharbi Nasser A, Alhabdan Sultan
General Surgery, King Abdulaziz Medical City, Riyadh, SAU.
College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU.
Cureus. 2023 Dec 26;15(12):e51143. doi: 10.7759/cureus.51143. eCollection 2023 Dec.
Laparoscopic sleeve gastrectomy (SG) is a widely performed bariatric procedure known for its safety and efficacy, yet complications, particularly postoperative leaks, remain a concern. Endoscopic stenting is one of the approaches for leak management that has some complications such as the rare fistula with adjacent organs. Here, we present a unique case of a 56-year-old diabetic female who developed a gastroenteric fistula following endoscopic stent placement for a post-SG leak. The patient had a delayed stent removal, and three weeks later she presented with dysphagia and vomiting in a follow-up appointment. Esophagogastroduodenoscopy (EGD) showed an esophageal stricture and a large gastroenteric fistula that was confirmed by imaging to be a fistula between the pylorus and proximal small bowel. The patient's symptoms improved gradually with conservative management, and imaging showed the resolution of the fistula and associated esophageal stricture. This case highlights the importance of timely stent removal (ideally within 6-8 weeks) and close follow-up with EGD and CT to detect and manage potential complications, while emphasizing the need for further research on optimal stent placement duration.
腹腔镜袖状胃切除术(SG)是一种广泛开展的减肥手术,以其安全性和有效性而闻名,但并发症,尤其是术后渗漏,仍然令人担忧。内镜支架置入是处理渗漏的方法之一,但也存在一些并发症,如罕见的与邻近器官形成瘘管。在此,我们报告一例独特病例,一名56岁的糖尿病女性在因SG术后渗漏行内镜支架置入术后发生胃肠瘘。患者支架移除延迟,三周后在随访预约中出现吞咽困难和呕吐。食管胃十二指肠镜检查(EGD)显示食管狭窄和一个大的胃肠瘘,影像学检查证实为幽门与近端小肠之间的瘘管。经保守治疗,患者症状逐渐改善,影像学检查显示瘘管及相关食管狭窄消失。该病例强调了及时移除支架(理想情况下在6 - 8周内)以及通过EGD和CT密切随访以检测和处理潜在并发症的重要性,同时强调需要进一步研究最佳支架置入持续时间。