Gastroventricular fistula in a patient with Roux-en-Y gastric bypass (with video)

Survival Following Gastro-Left Ventricular Fistula in a Patient Post Roux-en-Y Gastric Bypass

“…Finally, upper endoscopy will identify less than 50% of fistulas [3]. As in this case, a patient status post roux-en-Y gastric bypass poses a unique endoscopic challenge where double-balloon enteroscopy or intraoperative transabdominal endoscopy may be the only possible e52 endoscopic options for the remnant stomach [4]. Therefore, a high index of suspicion is required in these rare presentations, as many cases are diagnosed only at the time of autopsy [6].…”

“…The underlying etiology was also peptic ulcer disease. The patient underwent surgical exploration and cardiopulmonary bypass, but succumbed to multisystem organ failure within 24 hours of intervention [4].…”

“…Clinical presentation of a gastrocardiac fistula can be insidious, as a patient's initial presentation may have only vague symptoms of weakness, fatigue, and clinical findings of an iron-deficient microcytic anemia [6]. However, other patients may present with life-threatening illness, including gram-negative bacteremia, septic shock, massive gastrointestinal hemorrhage, peripheral emboli, and pericardial tamponade [3,4,7]. Physical examination may reveal the classic bruit du moulin ("water-wheel murmur"), which was first described by Bricheteau in 1844 [8].…”

Cutaneous Fistula from the Gastric Remnant Resulting from a Chronic Suture-associated Biofilm Infection

“…Of these, perhaps the most feared is a leak or fistula, typically arising from a dehiscence in the surgical staple line of the gastric pouch or perhaps from a perforated ulcer. Gastrogastric [1], gastrocutaneous [2], gastrobronchial [3], and even gastroventricular [4] fistulae have all been described, sometimes with dire consequences.…”

Gastrocardiac Fistula as a Complication of Prior Bariatric Surgery

“…A case report published in 2008 discussed gastroventricular fistula formation in a patient with prior Roux-en-Y gastric bypass. 4 He first presented to the hospital with non-specific left sided abdominal pain and had presented previously with episodes of melena and no underlying source. While admitted to a medical surgical floor, he suffered cardiac arrest and transferred to the ICU where emergent upper endoscopy revealed bright red blood in the afferent limb.…”