Management of sleeve gastrectomy leakage: case report

Treatment of postoperative gastric fistula complicated by local and systemic infection is difficult controversial, particularly when treating obese patients with multiple prior surgical procedures. A 41-year-old male patient was transferred to our hospital be admitted in the Intensive Care Unit respiratory failure sepsis, after being submitted bariatric surgery. He had been through four subsequent procedures: 1- a laparoscopic sleeve gastrectomy; 2- an exploratory laparotomy for unproven suspected subphrenic abscess; 3- splenectomy peritoneal drainage splenic peri-splenic 4-celiotomy lavage purulent peritonitis. Due persistent clinical analytical deterioration, suspicion left abscess digestive fistula, we proceeded to: identification abscess, adhesiolysis, orifice at cardiac incisure (methylene blue perioperative endoscopy), placement Pezzer tube directed controlled fistulization, Shirley’s drain space continuous lavage, jejunostomy enteral nutrition. Under imaging control (esophageal transit, fistulography computed tomography water-soluble contrasts) he started on water diet 2 months later removed. Patient discharged two half intervention, maintaing under nutrition jejunostomy. Oral feeding 3rd month probes were asymptomatic seven-month outpatient appointment.