Patiño-Araujo Bernarda, Salgado-Báez María, Villavicencio-Logroño Gabriel, Ayora-Pérez María, Zapata-Jaramillo Gabriela, Salgado-Macías Napoleón
Clínica Bariátrica Dr. Napoleón Salgado. Av. Mariana de Jesús OE7-02 and Nuño de Varderrama, Citimed, Ground floor Of. 2, Quito, Pichincha 170509, Ecuador.
J Surg Case Rep. 2025 Jun 3;2025(6):rjaf370. doi: 10.1093/jscr/rjaf370. eCollection 2025 Jun.
Esophageal perforation (EP) during laparoscopic sleeve gastrectomy is a rare but life-threatening complication. We report a case of a 46-year-old woman who developed late-onset EP, over 24 h postoperatively, following a sleeve gastrectomy, cholecystectomy, and hiatoplasty. The patient presented with epigastric pain, retrosternal discomfort, and dyspnea, and was diagnosed with a distal esophageal leak and mediastinitis. Surgical intervention included upper endoscopy, drainage tubes placement, thoracic and abdominal cavity lavage, and cervical esophagostomy. Postoperatively, the patient required intensive care for circulatory and ventilatory support, and antibiotic therapy was adjusted following positive culture results. Despite aggressive treatment, the patient remained in the intensive care unit for 12 days due to persistent systemic inflammatory response syndrome, but eventually recovered. This case emphasizes the importance of prompt diagnosis and management of EP in bariatric surgery. More research is needed to standardize treatment protocols for this rare but serious complication.
腹腔镜袖状胃切除术中的食管穿孔（EP）是一种罕见但危及生命的并发症。我们报告一例46岁女性病例，该患者在接受袖状胃切除术、胆囊切除术和贲门成形术后24小时以上出现迟发性EP。患者表现为上腹部疼痛、胸骨后不适和呼吸困难，被诊断为远端食管漏和纵隔炎。手术干预包括上消化道内镜检查、放置引流管、胸腹腔灌洗和颈部食管造口术。术后，患者需要重症监护以进行循环和通气支持，并根据阳性培养结果调整抗生素治疗。尽管进行了积极治疗，但由于持续的全身炎症反应综合征，患者在重症监护病房停留了12天，但最终康复。该病例强调了在减重手术中及时诊断和处理EP的重要性。对于这种罕见但严重的并发症，需要更多研究来规范治疗方案。
