Advertisement

Massive Gastrointestinal Bleeding Due to Splenic Artery Erosion by a PigTail Drain in a Post Sleeve Gastrectomy Leak: a Case Report

  • Elias Chahine
  • Antonio D’Alessandro
  • Mostafa Elhajjam
  • Frédéric Moryoussef
  • René-Louis Vitte
  • Robert Carlier
  • Salman Alsabah
  • Elie ChouillardEmail author
Letter to the Editor

Introduction

Digestive leak remains the main complication following surgery for morbid obesity, with an incidence rate of 1 to 5%, and a potential mortality rate between 0.1 and 5% [1, 2]. Historically, the management of leaks occurring after sleeve gastrectomy (SG) involved closure devices, including endoclips, over-the-scope clips and glue, or exclusion devices like self-expandable metallic stents (SEMS) [3, 4, 5, 6]. The rate of success of these approaches averaged 70% [5, 6]. However, these commonly required several endoscopic sessions, numerous hospitalizations, and produced significant discomfort for the patients. More specifically, SEMS could lead to serious complications including migration, bleeding, ingrowth, or even perforation or stripping in up to 6% of cases [7].

More recently, the initial management of post sleeve gastrectomy leak (SGL) has shifted towards internal endoscopic drainage (IED) using either nasocavity drains and/or pigtail drains (PTD) placed throughout the...

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval Statement

For this type of study, formal consent is not required.

Informed Consent Statement

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Rosenthal RJ, Diaz AA, Arvidsson D, et al. International sleeve gastrectomy expert panel consensus statement: best practice guidelines based on experience of > 12,000 cases. Surg Obes Relat Dis. 2012;8:8–19.CrossRefGoogle Scholar
  2. 2.
    Parikh M, Issa R, McCrillis A, et al. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Ann Surg. 2013;257:231–7.CrossRefGoogle Scholar
  3. 3.
    Shikora SA, Mahoney CB. Clinical benefit of gastric staple line reinforcement (SLR) in gastrointestinal surgery: a meta-analysis. Obes Surg. 2015;25:1133–41.CrossRefGoogle Scholar
  4. 4.
    Gagner M, Deitel M, Kalberer TL, et al. The second international consensus summit for sleeve gastrectomy, March 19–21, 2009. Surg Obes Relat Dis. 2009;5:476–85.CrossRefGoogle Scholar
  5. 5.
    Deitel M, Gagner M, Erickson AL, et al. Third international summit: current status of sleeve gastrectomy. Surg Obes Relat Dis. 2012;7:749–75.CrossRefGoogle Scholar
  6. 6.
    Gagner M, Deitel M, Erickson AL, et al. Survey on laparoscopic sleeve gastrectomy (LSG) at the fourth international consensus summit on sleeve gastrectomy. Obes Surg. 2013;23:2013–7.CrossRefGoogle Scholar
  7. 7.
    Puli SR, Spofford IS, Thompson CC. Use of self-expandable stents in the treatment of bariatric surgery leaks: a systematic review and meta-analysis. Gastrointest Endosc. 2012;75:287–93.CrossRefGoogle Scholar
  8. 8.
    Donatelli G, Dumont JL, Cereatti F, et al. Treatment of leaks following sleeve gastrectomy by endoscopic internal drainage (EID). Obes Surg. 2015;25:1293–301.CrossRefGoogle Scholar
  9. 9.
    Debs T, Petrucciani N, Kassir R, et al. Migration of an endoscopic double pigtail drain into the abdominal wall placed as a treatment of a fistula post revisional bariatric surgery. Obes Surg. 2017;27:1335–7.CrossRefGoogle Scholar
  10. 10.
    Genser L, Pattou F, Caiazzo R. Splenic abscess with portal venous gas caused by intrasplenic migration of an endoscopic double pigtail drain as a treatment of post-sleeve gastrectomy fistula. Surg Obes Relat Dis. 2016;12:1–3.CrossRefGoogle Scholar
  11. 11.
    Donatelli G, Airinei G, Poupardin E, et al. Double-pigtail stent migration invading the spleen: rare potentially fatal complication of endoscopic internal drainage for sleeve gastrectomy leak. Endoscopy. 2016;48:E74–5.CrossRefGoogle Scholar
  12. 12.
    Chouillard E, Chahine E, Schoucair N, et al. Roux-En-Y fistulo-jejunostomy as a salvage procedure in patients with post-sleeve gastrectomy fistula. Surg Endosc. 2014;28:1954–60.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of General & Minimally Invasive SurgeryPoissy Saint Germain Medical ComplexPoissyFrance
  2. 2.Department of Interventional RadiologyAmbroise Pare HospitalBoulogne-BillancourtFrance
  3. 3.Department of Interventional EndoscopyPoissy Saint Germain Medical CenterPoissyFrance
  4. 4.Department of Digestive and Bariatric SurgeryAmiri HospitalKuwait CityKuwait
  5. 5.Department of General Surgery & Minimally Invasive SurgeryPoissy Saint-Germain Medical ComplexPoissyFrance

Personalised recommendations