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Gastrosplenic Fistula with Gastrointestinal Bleeding: a Rare and Potentially Fatal Complication After Sleeve Gastrectomy

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Abstract

Background

Although the surgical technique is safe and standardized, laparoscopic sleeve gastrectomy (LSG) is associated with serious and potentially life-threatening complications, such as gastric leak and bleeding.

Methods

In this retrospective study, three French university hospitals reviewed their experience with LSG. Between September 2014 and May 2016, three cases of gastrosplenic fistula complicated by massive upper gastrointestinal hemorrhage (UGIH) were recorded.

Results

Patient number 1 experienced a massive UGIH 2 months after LSG. After blood transfusion, a transcatheter embolization of the splenic artery branch was successfully performed. Patient number 2 was admitted to the emergency department for massive UGIH 5 years after LSG. After several unsuccessful endoscopic attempts, she underwent a midline laparotomy, and an “en bloc” staple line resection and splenectomy was performed. Patient number 3 arrived at the hospital with an unstable hemodynamic status 16 days after the LSG and was given emergency surgery. She died as a consequence of hemorrhagic shock.

Conclusions

Post-LSG gastrosplenic fistula (GSF) is a rare and dreaded complication necessitating emergency management. Angiography with arterial embolization seems to be the treatment of choice for GSF following SG, allowing diagnosis and treatment when hemodynamic stability is warranted. In a life-threatening situation, hemostatic splenectomy remains the treatment of choice.

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Author information

Authors and Affiliations

  1. Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Digestive and Metabolic Surgery, Avicenne University Hospital, Université Paris XIII-UFR SMBH “Léonard de Vinci”, Bobigny, France

    Laura Montana & Christophe Barrat

  2. Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Digestive and Hepato-Pancreato-Biliary Surgery, Liver Transplantation, Pitié-Salpêtrière University Hospital, Sorbonne Université, 47-83 Boulevard de l’Hôpital, 75013, Paris, France

    Laurent Genser

  3. Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Digestive and Metabolic Surgery, Centre Hospitalier Marne la Vallée, Jossigny, France

    Alexandre Cortes

  4. Department of Digestive and Metabolic Surgery, Centre Hospitalier Intercommunal de Montfermeil, Montfermeil, France

    Eric Poupardin

  5. ELSAN, Surgical Obesity Center (CCO), Clinique Saint Michel, 4, place du 4 septembre, 83100, Toulon, France

    Sergio Carandina

Authors
  1. Laura Montana
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  2. Laurent Genser
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  3. Alexandre Cortes
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  4. Eric Poupardin
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  5. Christophe Barrat
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  6. Sergio Carandina
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Corresponding authors

Correspondence to Laurent Genser or Sergio Carandina.

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Conflict of Interests

The authors declare that they have no conflict of interest.

Statement of Informed Consent

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

Statement of Human Rights

All of the procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional research committee and the 1964 Helsinki.

Additional information

Laura Montana and Laurent Genser equally contributed to the manuscript and are co-first authors.

The present study has been presented to the 22th congress of the International federation for the surgery of obesity and metabolic disorders (IFSO) in London, UK, 29 August–2 September, 2017 (poster session). 

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Montana, L., Genser, L., Cortes, A. et al. Gastrosplenic Fistula with Gastrointestinal Bleeding: a Rare and Potentially Fatal Complication After Sleeve Gastrectomy. OBES SURG 28, 2135–2139 (2018). https://doi.org/10.1007/s11695-018-3284-y

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  • DOI: https://doi.org/10.1007/s11695-018-3284-y

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