Gastrocolic fistula after laparoscopic sleeve gastrectomy: Case report and literature review

Highlights • Leakage after sleeve gastrectomy is the cornerstone for most of its related morbidity and mortality. • Gastrocolic fistula is a rare complication resulting from chronic leak after laparoscopic sleeve gastrectomy. • A high index of suspicion is important in detection of rare complications including gastrocolic fistula. • Complete laparoscopic resection of gastrocolic fistula is preferred. • Gastrectomy might be the definitive surgery. • Re-do bariatric surgery should be only done by an expert bariatric surgeon with multidisciplinary team in a specialized center.
Introduction Laparoscopic sleeve gastrectomy is a popular bariatric procedure. Leakage after sleeve gastrectomy is the cornerstone for most of its related morbidity and mortality. Gastrocolic fistula is a rare complication resulting from chronic leak after laparoscopic sleeve gastrectomy. Case presentation We report a case of 32-year-old male who underwent laparoscopic re-sleeve gastrectomy for weight regain after initial uneventful laparoscopic sleeve gastrectomy 3 years back. He presented to emergency department by septic shock secondary to leakage after sleeve gastrectomy. CT abdomen with IV contrast and oral gastrograffin confirmed post sleeve gastrectomy leak. Emergency diagnostic laparoscopy revealed a huge abscess cavity containing pus and dark fecal material and altered blood. A long leak was identified with eversion of gastric mucosa. Tubular structure connecting the upper part of the stomach and the colon was found which turned out to be a gastrocolic fistula. It was controlled by endoscopic linear stapler. After 6 weeks, a definitive open esophago-jeujonostomy with total gastrectomy was done successfully after difficult attempt of laparoscopic intervention. The patient was discharged home in a stable condition. Conclusion A high index of suspicion is important in detection of rare complications after laparoscopic sleeve gastrectomy including gastrocolic fistula. Complete laparoscopic resection of gastrocolic fistula is preferred. Gastrectomy might be the definitive surgery.