management of haematemesis in this patient prior to surgery. 5 Ultimately, however, after endoscopic haemostasis, surgical management of the complex chronic fistula in this case was successful.Although rare, chronic gastric fistula should remain as a differential in any patient post-bariatric surgery who presents with recurrent unexplained pneumonia, haematemesis or abnormal radiology findings. Overall, this is a rare and complex situation with evidence base for treatment limited to case reports only. Management requires a multi-disciplinary approach between the bariatric surgeons, gastroenterologists and radiologists.