[Gastro-bronchial fistula major complication of sleeve gastrectomy].

Abstract

BACKGROUND:

Gastrobronchial fistula is a rare complication in gastroesophageal surgical procedures. It is difficult to diagnose and handling is complex. Therefore, there have been developments for non-surgical alternatives to obliterate minor fistula mortality. Endoscopic treatment is an option for patients with small fistulas or in serious condition.

CLINICAL CASE:

A 38 year old woman with evidence of gastrobronchial fistula postoperated of gastric sleeve, diagnosed during the postoperative period due to clinical variegated was initially handled as infectious respiratory symptoms; once the fistulous path was established, the intention was to close the path using endoclips. However, adding hemopneumothorax, drainage tube placement and thoracotomy were required. It was decided to chose a prosthetic esophageal endoscopic management of polytetraflouroethylene and fibrin as last therapy, because the patient had systemic inflammatory response syndrome, with favorable response to endoscopic management.

DISCUSSION:

Bariatric surgery has shown satisfactory results, however, the complexity of the procedure favors severe complications such as the present case. Gastrobronchial fistulas represent a diagnostic and therapeutic challenge, this is considering from a conservative management to endoscopic procedures, as in our patient.

CONCLUSION:

Although gastrobronchial fistulas are a rare complication, the use of endoscopy in resolution should be a first class weapon in its management, since it offers a lower morbidity in a patient with habitual respiratory symptoms that are difficult to control, with satisfactory results in the medium and long term.

• Authors: Luis Alberto Guerrero-Silva, Servando López-García, Fernando Guardado-Bermúdez, Fernando Josafat Ardisson-Zamora, Alberto Medina-Benítez, Fernando Corona-Suárez
• Journal: Cirugia y cirujanos (Cir Cir) 2015 Jan-Feb Vol. 83 Issue 1 Pg. 46-50 ISSN: 2444-054X [Electronic] Mexico
• Vernacular Title: Fístula gastrobronquial: complicación mayor de manga gástrica.
• PMID: 25982608 (Publication Type: Case Reports, English Abstract, Journal Article)
• Copyright: Copyright © 2015. Published by Masson Doyma México S.A.

Chemical References

• Fibrin Tissue Adhesive

Topics

• Adult
• Bronchial Fistula (diagnosis, etiology)
• Diagnostic Errors
• Drainage
• Esophagoscopy
• Female
• Fibrin Tissue Adhesive (therapeutic use)
• Gastrectomy (methods)
• Gastric Fistula (diagnosis, etiology)
• Hemothorax (etiology, surgery)
• Humans
• Pneumothorax (etiology, surgery)
• Postoperative Complications (diagnosis, etiology)
• Prosthesis Implantation
• Respiratory Tract Infections (diagnosis)
• Systemic Inflammatory Response Syndrome (etiology)
• Thoracotomy