Gastropleural Fistula as a Rare Complication of Gastric Sleeve Surgery: A Case Report and Comprehensive Literature Review

Abstract

Gastropleural fistula (GPF) is a rare, life-threatening complication of gastric sleeve surgery. GPF is an uncommon differential diagnosis to consider in a patient presenting with a picture of pneumonia. As such, GPF should be suspected in a patient with a history of nonresolving pneumonia who recently underwent gastric sleeve surgery. To the best of our knowledge, only eight cases of gastropleural fistulas after bariatric surgery have been reported in the literature. Herein, we report a case of gastropleural fistula after gastric sleeve surgery and review the pertinent literature. A gastropleural fistula is an exceedingly rare and life-threatening complication postbariatric surgery. Nonsurgical conservative management (total parenteral nutrition, percutaneous drainage, and antibiotics with endoscopic stenting) can be considered.

Late Gastropleural Fistula Following Bariatric Surgery: Case Report

“…Although the precise mechanism for its formation has not been completely elucidated, their development has been related to post-surgical leaks, which promote the formation of abscesses responsible for the structural elaboration of the fistulous tract. Until a communication between the gastric tract and the pleural cavity is complete, the time required for fistula formation and the emergence of the first symptoms may vary considerably, ranging from a period of two months up to thirteen years [11]. The clinical presentation is often insidious, and the main symptoms include temperature and dyspnea [15], productive cough and recurrent pneumonia [11]; chest pain and dry cough [16]; abdominal pain [17], and septic shock [18].…”

“…Until a communication between the gastric tract and the pleural cavity is complete, the time required for fistula formation and the emergence of the first symptoms may vary considerably, ranging from a period of two months up to thirteen years [11]. The clinical presentation is often insidious, and the main symptoms include temperature and dyspnea [15], productive cough and recurrent pneumonia [11]; chest pain and dry cough [16]; abdominal pain [17], and septic shock [18]. The suspicion, identification, and treatment of GPF is crucial to avoid serious complications for the patient.…”

A Rare Complication of Noncompliance Status Post-Transhiatal Esophagectomy and Esophago-Gastroanastomosis

“…In the absence of universal guidelines, there are conflicting reports on the proper care of GPF. A majority of reports agree that the laparoscopic approach and surgical interventions are definitive treatments as data indicate higher mortality with conservative management [ 7 – 9 ]. Meta-analysis of several case reports and retrospective studies has evaluated the outcomes of various surgical and endoscopic interventions.…”

“…GPF are infrequent and life-threatening with insidious onset and nonspecific symptoms. This diagnosis has been historically difficult to establish and is often misdiagnosed, as is noted in several reviews and case reports [ 2 , 5 – 7 ]. A high index of suspicion should be held in patients with significant risk factors including previous surgeries, malignancy, and gastric ulcerations.…”

“…Gastropleural fistulas (GPFs) are a rare and dangerous complication of different pathologies including peptic ulcer disease, trauma, infections, surgical complications, and malignancy [ 1 ]. Presentation is typically insidious, and symptoms may include abdominal and chest pain, respiratory failure, and signs of septic shock [ 1 – 7 ]. Treating physicians should have a high index of suspicion with high-risk patients, as prompt diagnosis is essential to decrease mortality in this life-threatening diagnosis.…”