Successful management of late leakage after sleeve gastrectomy: A case of a challenging delayed complication

Abstract

Merab A. Kiladze, George Kherodinashvili, Elza Apriamashvili, Koba Sakhechidze, Malkhaz Chubinidze, Paata Tutberidze, Irakli Gogokhia

We report a unique case of delayed complication of a 36-year-old obese female patient who had a very late gastric leak, namely, four years after LSG. Patient presented with worsening abdominal pain and discomfort, anemia, intermittent fever of 39°C, vomiting and a general feeling of illness and anxiety. Clinical, laboratory and instrumental studies (X-Ray, CT, US) revealed the leakage from the gastric remnant at the gastroesophageal junction level and a small left subdiaphragmatic collection. Revisional laparoscopy and intraoperative methylene blue test (MBT) did not reveal a defect and leakage of the suture line. On rehospitalization the surgical intervention was recommended. The successful extirpation of the stomach remnant with resection of distal segment of esophagus and Roux-en-Y reconstruction was performed. The control X-Ray examination was performed at 6th p/o day, which reveals no extravasation and free passage of contrast to the distal part of GI tract. The patient started peroral eating and was discharged the Hospital at 10th p/o day. At control X-Ray examination after 1 month of surgery the patient is doing well. We consider, that this surgical procedure seems to be the most optimal and radical surgical intervention in similar cases.

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