Abstract
Weight loss surgeries are evident to be highly beneficial in patients with morbid obesity (body mass index (BMI) ≥40.0 kg/m2) and severe obesity (BMI between 35.0 and 39.9 kg/m2 with co-morbidities). While this results in significant mortality benefit, there is always the possible risk of postsurgical complications. Gastrobronchial and gastropleural fistulas are two rare, post-operative pulmonary complications associated with these surgeries. Our patient is a 54-year-old female who underwent a biliopancreatic diversion with a duodenal switch. A few weeks later, she started developing a cough, fever, and shortness of breath. Computed tomography (CT) chest showed the presence of a loculated right sided hydropneumothorax. A gastrointestinal fluoroscopic contrast study performed showed a large fistula originating from the distal end of the stomach and ending towards the right pleural cavity. The fistula was successfully closed with the endoscopic fulguration of fistulous opening with argon beam coagulation and orthoscopic clipping, resulting in complete obliteration of the fistula tract. The right-sided hydropneumothorax was initially treated conservatively with antibiotics and chest tube drains followed by video-assisted thoracoscopic decortication with chest tube placement. Gastropleural fistula formation is rare but is nonetheless a serious postoperative complication of bariatric procedures and mimics pneumonia clinically. It is, therefore, essential to obtain detailed imaging work-up to rule out fistula formation, which, in turn, can be timely treated without causing further devastating results to the patient.
Highlights
Weight loss surgeries are considered in patients aged 18-60 years, with morbid obesity, body mass index (BMI) ≥40.0 kg/m2,or severe obesity, BMI between 35.0 and 39.9 kg/m 2, with comorbidities such as diabetes and other metabolic disorders, cardiorespiratory disease, and severe joint disease, in whom weight loss is expected to improve outcomes from those comorbidities [1]
There are four common types of weight loss surgery practiced in the United States: Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, sleeve gastrectomy, and duodenal switch with biliopancreatic diversion [2]
There was a fistulous connection evident, extending from the surgical anastomosis in the stomach/bowel in the right upper quadrant through the right hemidiaphragm to the right hemithorax. These Computed tomography (CT) scan findings were new as compared to a CT scan obtained for this patient six months prior to the duodenal switch when she presented to the emergency department for non-specific left-sided chest pain
Summary
Weight loss surgeries are considered in patients aged 18-60 years, with morbid obesity, body mass index (BMI) ≥40.0 kg/m2,or severe obesity, BMI between 35.0 and 39.9 kg/m 2, with comorbidities such as diabetes and other metabolic disorders, cardiorespiratory disease, and severe joint disease, in whom weight loss is expected to improve outcomes from those comorbidities [1]. A chest X-ray performed showed a right lung infiltrate with a right-sided pleural effusion She was started on treatment with augmentin 500 mg/125 mg every eight hours. There was a fistulous connection evident, extending from the surgical anastomosis in the stomach/bowel in the right upper quadrant through the right hemidiaphragm to the right hemithorax These CT scan findings were new as compared to a CT scan obtained for this patient six months prior to the duodenal switch when she presented to the emergency department for non-specific left-sided chest pain. A repeat EGD was performed along with fulguration of a fistulous opening with argon beam coagulation and repeat orthoscopic clip application with complete obliteration of the fistula tract This was confirmed by an upper gastrointestinal contrast study showing no persistent fistulous communication between the post-bulbar duodenum and pleural space (Figure 3). The patient was discharged home after the procedure and has been followed by multidisciplinary teams on an outpatient basis
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
