Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Salamanca - Paseo de la transición española, 37007, Salamanca, Spain.
Obes Surg. 2024 May;34(5):1990-1992. doi: 10.1007/s11695-024-07198-1. Epub 2024 Apr 2.
ESG is a safe and effective technique in the obesity management, usually indicated in class I and II obesity. It is also an acceptable treatment in patients with class III obesity who have high surgical risk or refuse surgery. This procedure results in a significant weight loss and important improvement in metabolic comorbidities. Nevertheless, there are several procedure-related complications. Few cases of gastric perforation following ESG have been reported. We present a case of septic shock after ESG with preoperative diagnostic uncertainties.
We present the case of a 54-year-old male with a BMI of 43.6 kg/m2 who underwent ESG 7 days before in an external center. The patient came to the emergency department presenting abdominal pain, nausea, and vomiting since the day after the procedure. Physical examination revealed hemodynamic instability, altered level of consciousness, diffuse abdominal pain, and a painful umbilical lump due to a complicated umbilical hernia. Emergent surgery was decided after preoperative assessment.
Intraoperative gastroscopy was performed, viewing a gastric ischemic ulcer covered with fibrin and a mucosal defect and suspecting a covered gastric perforation. Firstly, we performed an open approach to the complicated umbilical hernia. Subsequently, an exploratory laparoscopy was performed through the hernial ring, where a fibrin-covered area was evidenced in the anterior face of the gastric body, adhered to the round ligament by a transmural suture of the ESG. Additionally, multiple transmural sutures were observed adhered to the greater omentum and lesser sac and an intramural hematoma in the greater gastric curvature. No intra-abdominal free fluid was evidenced. A laparoscopic barbed suture of the area covered with fibrin was performed, after its release from the round ligament. The adhesions of the sutures and metallic material from the ESG were released. Finally, two abdominal drains were placed in the anterior and posterior gastric face. The patient presented superficial incisional surgical site infection and was discharged 6 days after laparoscopic surgery.
ESG is a novel procedure, which has proven to be an effective alternative in the treatment of obesity. However, this technique may have major complications that can require urgent surgery.
ESG 是一种安全有效的肥胖管理技术，通常适用于 I 类和 II 类肥胖。对于有高手术风险或拒绝手术的 III 类肥胖患者，它也是一种可接受的治疗方法。该手术可显著减轻体重，并显著改善代谢合并症。然而，该手术存在一些与手术相关的并发症。已有少数报道称 ESG 后发生胃穿孔。我们报告了一例 ESG 后发生感染性休克的病例，术前诊断不确定。
我们报告了一例 54 岁男性病例，BMI 为 43.6kg/m2，7 天前在外部中心接受 ESG 治疗。该患者术后第 2 天出现腹痛、恶心和呕吐，来到急诊就诊。体格检查显示血流动力学不稳定、意识改变、弥漫性腹痛和脐疝疼痛性肿块。经术前评估后决定行紧急手术。
术中进行了胃镜检查，观察到一个覆盖纤维蛋白的胃缺血性溃疡和一个黏膜缺损，怀疑存在覆盖性胃穿孔。首先，我们采用开放式方法处理复杂的脐疝。随后，通过疝环进行腹腔镜探查，在前腹壁胃体上发现一个纤维蛋白覆盖区域，与 ESG 的穿壁缝线一起附着在圆韧带。此外，还观察到多个穿壁缝线附着在大网膜和小网膜上，以及大胃弯的壁内血肿。未发现腹腔内游离液。对覆盖纤维蛋白的区域进行了腹腔镜带刺缝线缝合，缝线从圆韧带松解后进行。松解 ESG 的缝线和金属材料的粘连。最后，在前胃面和后胃面放置了两个腹部引流管。患者出现浅表切口手术部位感染，腹腔镜手术后 6 天出院。
ESG 是一种新的手术方法，已被证明是肥胖治疗的有效替代方法。然而，该技术可能会出现严重的并发症，需要紧急手术。
