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Gastrobronchial Fistula after Obesity Surgery
Gastrobronchial Fistula after Obesity Surgery Josemberg M Campos, MD, PhD, Luciana T Siqueira, MD, Álvaro AB Ferraz, MD, PhD, Edmundo M Ferraz, MD, PhD, FACS, Pernambuco Federal University, Recife, Brazil
thick white arrow), originating from the noncontrasting area of the fistula (A, dotted line). Classic treatment of digestive tract fistula includes curing the distal stenosis. This patient’s gastrobronchial fistula was treated endoscopically by incision of the gastric stricture, using a needle-knife catheter with electrical current. Pneumatic endoscopic dilation with a balloon catheter (30 mm diameter after inflation) was performed. After 35 days the diameter of the gastric pouch had enlarged (C, black arrow) and the fistula had definitively closed (C, white arrow). The reoperations and the initial sessions of endoscopic dilation were not successful because the fibrous stricture of the gastric pouch hindered the passing of food, and this caused recurrent infection resulting in the development of the gastrobronchial fistula. Five consecutive sessions of endoscopic stricturotomy and balloon dilation completely resolved the gastric distal obstruction and this cured the fistula. Six months later there was no recurrence.
A 22-year-old patient underwent a ring Roux-en-Y bypass to treat morbid obesity. Over a 2.5-year period after surgery the patient developed pulmonary and subphrenic (A, 3) abscesses, gastric pouch stenosis (A, thick black arrow), and a fistula at the angle of His (A, thin white arrow). Three relaparatomies were performed in other hospitals, but it was not possible to reach the fistula area because of intense fibrosis. Endoscopic treatment of the gastric pouch and of the gastrojejunal anastomosis with dilation and fibrin glue was unsuccessful.1 An endoscopic image from the esophagogastric junction (B, white arrows), shows the internal orifice of the fistula at the angle of His (B, thin black arrow) with a catheter (B, black arrowhead) and a gastric pouch stenosis (B, thick black arrow). The persistent subphrenic abscess caused an inflammatory process in the left diaphragm, resulting in purulent drainage to the bronchial tree (A,
© 2007 by the American College of Surgeons Published by Elsevier Inc.
REFERENCE 1. Rábago LR, Ventosa N, Castro JL, et al. Endoscopic treatment of postoperative fistulas resistant to conservative management using biological fibrin glue. Endoscopy 2002;34:632–638.
711
ISSN 1072-7515/07/$32.00 doi:10.1016/j.jamcollsurg.2006.07.049
thick white arrow), originating from the noncontrasting area of the fistula (A, dotted line). Classic treatment of digestive tract fistula includes curing the distal stenosis. This patient’s gastrobronchial fistula was treated endoscopically by incision of the gastric stricture, using a needle-knife catheter with electrical current. Pneumatic endoscopic dilation with a balloon catheter (30 mm diameter after inflation) was performed. After 35 days the diameter of the gastric pouch had enlarged (C, black arrow) and the fistula had definitively closed (C, white arrow). The reoperations and the initial sessions of endoscopic dilation were not successful because the fibrous stricture of the gastric pouch hindered the passing of food, and this caused recurrent infection resulting in the development of the gastrobronchial fistula. Five consecutive sessions of endoscopic stricturotomy and balloon dilation completely resolved the gastric distal obstruction and this cured the fistula. Six months later there was no recurrence.
A 22-year-old patient underwent a ring Roux-en-Y bypass to treat morbid obesity. Over a 2.5-year period after surgery the patient developed pulmonary and subphrenic (A, 3) abscesses, gastric pouch stenosis (A, thick black arrow), and a fistula at the angle of His (A, thin white arrow). Three relaparatomies were performed in other hospitals, but it was not possible to reach the fistula area because of intense fibrosis. Endoscopic treatment of the gastric pouch and of the gastrojejunal anastomosis with dilation and fibrin glue was unsuccessful.1 An endoscopic image from the esophagogastric junction (B, white arrows), shows the internal orifice of the fistula at the angle of His (B, thin black arrow) with a catheter (B, black arrowhead) and a gastric pouch stenosis (B, thick black arrow). The persistent subphrenic abscess caused an inflammatory process in the left diaphragm, resulting in purulent drainage to the bronchial tree (A,
© 2007 by the American College of Surgeons Published by Elsevier Inc.
REFERENCE 1. Rábago LR, Ventosa N, Castro JL, et al. Endoscopic treatment of postoperative fistulas resistant to conservative management using biological fibrin glue. Endoscopy 2002;34:632–638.
711
ISSN 1072-7515/07/$32.00 doi:10.1016/j.jamcollsurg.2006.07.049