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Bleeding after stenting

Case study: aorto-oesophageal fistula bleeding

The first case of aorto-oesophageal fistula bleeding after stenting for a leak post-sleeve gastrectomy

Researchers from the King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia, has reported what they believe to be the first case of aorto-oesophageal fistula bleeding after stenting for a leak post-sleeve gastrectomy. They reported the case study in the World Journal of Gastrointestinal Surgery.

The authors write that although bariatric surgery is used as a modality to treat obesity, it is associated with some complications of which surgical leaks are one of the most unfavourable. In particular they note that the management of staple line leaks post-sleeve gastrectomy now includes the use of oesophageal self-expandable metal stents (SEMS) or self-expandable plastic stents (SEPS) to occlude the leaks.

Their case study focuses on an unusual case where a SEMS resulted in a massive gastrointestinal bleed secondary to an aorto-oesophageal fistula.

The patient was a 43-year old female who had undergone a laparoscopic sleeve gastrectomy that was complicated by a proximal gastric pouch leak at the gastroesophageal junction.

An esophagogastroduodenoscopy (EGD) showed an opening at the area of the staple line at the gastroesophageal junction (Figure 1A) and a 12cm fully-covered SEMS was inserted (Figure 1B).

Figure 1A/B: An opening at the area of the staple line near the gastroesophageal junction (A): A 12cm fully covered self-expandable metal stent was inserted in the esophagus and overlapped the staple line leak (B).

Seven weeks after the insertion of the initial SEMS, the patient presented with a massive gastrointestinal bleed that could not be localised due to profuse bleeding.

Although the patient underwent a CT angiogram and an angiogram, it was not until an emergency laparotomy was performed that the source of bleeding was identified be an aorto-oesophageal fistula.

“To our knowledge, this is the first case that reports an aortoesophageal fistula as a result of a SEMS for the management of a gastric pouch leak after a laparoscopic sleeve gastrectomy,” the authors write.

To access the article, please click here

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