Endoscopic Drainage of Intra-Abdominal Collection after Bariatric Surgery.

Abstract

Symptomatic intra-abdominal collection after bariatric surgery occurs in up to 5% of cases. Surgical, percutaneous, or endoscopic drainage are the feasible approaches. In this video, we show the case report of a 50-year-old woman who underwent to gastric omega bypass on a previous sleeve gastrectomy. After 3weeks, she presented a well-organized liquid collection just behind the longitudinal staple line of the gastric pouch. No passage of contrast from the gastrointestinal tract to the collection was highlighted. Endoscopic ultrasound drainage approach failed due to tightness of the gastric pouch. Therefore, direct endoscopic drainage was successfully performed using CT scan images as guidance and according to fluoroscopic visualization of the staple line. The patient fully recovered, and she was discharged 48h after endoscopy with complete normalization of inflammatory markers (CRP and leukocytosis). Upper GI endoscopy has been scheduled in 3months in order to plan the removal of the stents. We managed such surgical complication creating a fistula between the gastric remnant and the collection achieving an internal drainage of the intra-abdominal fluid collection. The concept of internally drain any fluid collection with endoscopically delivered double pigtails plastic stents is gaining momentum and has been demonstrated effective in the management of leak following bariatric and upper GI surgery too.