Gastro-Pleural Fistula Following Laparoscopic Sleeve Gastrectomy Masquerading as Loculated Empyema Thoracis: a Diagnostic Dilemma

Excerpt

Laparoscopic sleeve gastrectomy (LSG) is one of the most frequently performed bariatric surgical procedures worldwide. It is a relatively simple procedure and major complications following LSG are unusual. Staple line leak following LSG is a rare but serious complication, which may result in significant morbidity. Staple line leaks occur in 1–3% of patients undergoing LSG, majority being located at proximal end of the staple line. [1, 2] Rarely, complex fistulae may form, which tend to have delayed presentations. Gastro-pleural fistula (GPF) is an exceedingly rare but potentially fatal complication following LSG. In a review of literature published in 2018, Alghanim et al. described only eight cases of GPF following sleeve gastrectomy. [3] With increasing incidence of morbid obesity and a corresponding increase in bariatric surgical procedures, more of such cases are now being reported. Our literature search revealed fewer than 50 cases of post-sleeve gastrectomy GPF in medical literature. Surgeons must be aware of this entity so as to avoid undue morbidity and mortality. We, thus, report an unusual case of post-LSG leak with gastro-pleural fistula, manifesting as loculated empyema thoracis months after the surgery. …