Long Esophageal Segment Laceration Caused by an Orogastric Tube During Laparoscopic Sleeve Gastrectomy

Abstract

A 36-year-old woman with a body mass index of 34.5 kg/m2 was admitted because of morbid obesity and type II diabetes mellitus. She had tried unsuccessfully to lose weight at least twice in the past, and her diabetes had not been well controlled recently (hemoglobin A1c, 10.1%). In addition, she had a history of 2 cesarean sections. Laparoscopic sleeve gastrectomy was performed in a standard fashion, and the entire staple line was reinforced with continuous Lembert sutures. At the end of the procedure, a leakage test was performed through an orogastric tube and no sign of contrast leakage was noted. After the operation, the patient had mild sustained tachycardia with a mild fever that continued into postoperative day 1. A chest roentgenogram showed right-sided pleural effusion also. A Gastrografin (Bayer New Zealand Ltd, Auckland, NZ) swallow test was performed immediately, which showed massive contrast leakage to the right pleural cavity, indicating distal esophageal rupture (Fig 1). Surgical exploration was performed, revealing a 5-cm longitudinal esophageal laceration at the distal esophagus (Fig 2). The laceration was repaired primarily with reinforcement of the parietal pleura. The postoperative course was uneventful, and the patient was discharged with no complications.Fig 2View Large Image Figure ViewerDownload (PPT)Laparoscopic sleeve gastrectomy is becoming a popular bariatric restrictive procedure. Orogastric tubes may cause life-threatening complications such as esophageal rupture. Therefore, surgeons must take into consideration this possibility and intervene in a timely fashion. A 36-year-old woman with a body mass index of 34.5 kg/m2 was admitted because of morbid obesity and type II diabetes mellitus. She had tried unsuccessfully to lose weight at least twice in the past, and her diabetes had not been well controlled recently (hemoglobin A1c, 10.1%). In addition, she had a history of 2 cesarean sections. Laparoscopic sleeve gastrectomy was performed in a standard fashion, and the entire staple line was reinforced with continuous Lembert sutures. At the end of the procedure, a leakage test was performed through an orogastric tube and no sign of contrast leakage was noted. After the operation, the patient had mild sustained tachycardia with a mild fever that continued into postoperative day 1. A chest roentgenogram showed right-sided pleural effusion also. A Gastrografin (Bayer New Zealand Ltd, Auckland, NZ) swallow test was performed immediately, which showed massive contrast leakage to the right pleural cavity, indicating distal esophageal rupture (Fig 1). Surgical exploration was performed, revealing a 5-cm longitudinal esophageal laceration at the distal esophagus (Fig 2). The laceration was repaired primarily with reinforcement of the parietal pleura. The postoperative course was uneventful, and the patient was discharged with no complications. Laparoscopic sleeve gastrectomy is becoming a popular bariatric restrictive procedure. Orogastric tubes may cause life-threatening complications such as esophageal rupture. Therefore, surgeons must take into consideration this possibility and intervene in a timely fashion.