Gastropleural fistula in metastatic ovarian cancer

Abstract

Gastropleural fistula is a rare condition, most frequently reported as a result of trauma, peptic ulcer disease or malignancy. We report a case of gastropleural fistula in a patient with metastatic ovarian cancer who presented with hydropneumothorax and mediastinal shift. She was successfully managed with an open partial gastrectomy, repair of diaphragmatic defect, and thoracoscopic washout and decortication. Based on our case and review of the literature, surgical repair of gastropleural fistula should be considered as a palliative procedure even in patients with end-stage cancer.

Pediatric Gastropleural fistula, a complication of Sleeve gastrectomy: Case report and brief review.

“…Since then, it has been reported secondary to trauma, peptic ulcer disease, malignancy (lymphoma and gastric tumors), and due to the spread of infection from adjacent structures such as subdiaphragmatic abscess, empyema, or invasive fungal infection in immunocompromised patients. Recently, with the emerging of obesity related bariatric surgeries, GPF has been documented as a complication of such surgeries in adult patients 4 . One of those surgeries is SG which has been utilized in pediatric patients to a lesser extent 2 .…”

“…Diagnosis of GPF requires a high index of suspicion and thorough investigations 4 . Initial workup includes CXR, which may demonstrate pneumothorax, pleural effusion, or hydropneumothorax 4 . Upper GI series, preferably with water-soluble contrast, might show contrast extravasation to the pleural cavity 6 .…”

Gastropleural Fistula with Aortic Intramural Involvement

“…[3] Patients who have a prior history of thoracic or upper abdominal surgery, as well as local radiation therapy, are also at risk. [45] Our patient had no known risk factors for fistula formation.…”

“…Gastropleural fistulas are rare conditions that are typically seen in the setting of trauma and diaphragmatic injury or gastric perforation secondary to peptic ulcer disease and malignancy. [ 3 ] Patients who have a prior history of thoracic or upper abdominal surgery, as well as local radiation therapy, are also at risk. [ 4 5 ] Our patient had no known risk factors for fistula formation.…”

“…Additional imaging findings that can be found in the presence of a gastropleural fistula include hydropneumothorax and tension pneumothorax. [ 3 ]…”