Obesity Surgery

, Volume 19, Issue 2, pp 265–268 | Cite as

Development of a Gastric Pouch-Aorto-Colic Fistula as a Complication of a Revisionary Open Roux-en-Y Gastric Bypass

  • Mario Raul Villalba
  • Mario Ramon VillalbaEmail author
Case Report


A 45-year-old female presented with an enterocutaneous fistula and intraabdominal abscesses weeks after undergoing an open roux-en-y gastric bypass 20 years after a previous bariatric procedure. Initial management consisted of exploration with resection of the fistula, open abscess drainage, percutaneous drains, and culture-directed intravenous antibiotics. Months later, the patient developed a gastrocolic fistula and massive upper gastrointestinal bleeding from a gastro-aortic fistula. The patient underwent resection of the gastrocolic fistula followed by a damage control operation including a left thoracotomy with aortic cross-clamping for the gastro-aortic fistula. Final reconstruction necessitated an extra-anatomic opening in the diaphragm for creation of an intrathoracic esophagojejunostomy and marsupialization of the distal esophagus and gastric pouch with concomitant mucusectomy. This rare but devastating complication requires prompt surgical management. In the appropriate setting, a high suspicion must be maintained in order to act swiftly for the patient’s benefit


Roux-en-Y gastric bypass Massive gastrointestinal bleed Gastro-aortic fistula Intraabdominal sepsis Gastrocolic fistula 


  1. 1.
    Deitel M. Overweight and obesity worldwide now estimated to involve 1.7 billion people (editorial). Obes Surg. 2003;13:329–30.CrossRefGoogle Scholar
  2. 2.
    Delin CR, Watts JM, Bassett DL. An exploration of the outcomes of gastric bypass surgery for morbid obesity: patient characteristics and indices of success. Obes Surg. 1995;5:159–70.CrossRefGoogle Scholar
  3. 3.
    Montgomery RS, Wilson SE. The surgical management of aortoenteric fistulas. Surg Clin North Am. 1996;76(5):1147–57.CrossRefGoogle Scholar
  4. 4.
    Daneels MIL, Nevelsteen A, Vermassen FEG. Endovascular repair for aorto-enteric fistula: a bridge too far or a bridge to surgery. Eur J Vasc Endovasc Surg. 2006;32:27–33.CrossRefGoogle Scholar
  5. 5.
    Antinori CH, Andrew CT, Manuele VJ. The many faces of aortoenteric fistulas. Am Surgeon. 1996;62:344–49.PubMedGoogle Scholar
  6. 6.
    Bustill SJ, Goldstone J. Diagnosis and management of aortoenteric fistulas. Semin Vasc Surg. 2001;14:302–11.CrossRefGoogle Scholar
  7. 7.
    Brountzos EN, Vasdekis S, Perros G. Endovascular treatment of a bleeding secondary aorto-enteric fistula. A case report with 1-year follow-up. Cardiovasc Interv Radiol. 2007;30:1037–41.CrossRefGoogle Scholar
  8. 8.
    Armitage NC, Ballantyne RC. Primary aortodoudenal fistula due to recurrent colorectal carcinoma. Report of a case. Dis Colon Rectum. 1990;33: 148–9.CrossRefGoogle Scholar
  9. 9.
    Estrada FP, Tachovsky TJ, Orr RM. Primary aortodoudenal fistula following radiotherapy. Surg Gynecol Obstet. 1983;156:646–50.PubMedGoogle Scholar
  10. 10.
    Moulton S, Adams M, Johansen K. Aortoenteric fistula: a 7-year urban experience. Am J Surg. 1986;151:607–11.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  1. 1.Department of General SurgeryWilliam Beaumont HospitalRoyal OakUSA
  2. 2.Surgical Critical CareWilliam Beaumont HospitalRoyal OakUSA
  3. 3.Royal OakUSA

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