A 25-year-old patient underwent laparoscopic Roux-en-Y gastric bypass surgery with an initially uneventful postoperative course. Two weeks postoperatively, the patient presented with acute abdominal pain. CT scan revealed a gastrogastric fistula from the gastric pouch to the gastric remnant. Laparoscopic drainage was performed, and intraoperative endoscopy confirmed a large gastrogastric fistula. Due to intense adhesions between pouch and remnant, a closure by suture of the fistula was not possible. The fistula was initially treated with a fully covered metal stent. After multiple stent migrations despite clip attachment to the mucosa, the stent was changed to a partially covered metal stent. Fistula healing progress was documented every 2 weeks. After 10 weeks of stent treatment, fistula closure was accomplished.
In conclusion, early fistula from the gastric pouch to the gastric remnant is a rare complication and can be managed with endoscopic stent placement.
- metabolic disorders
- gastrointestinal surgery
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Contributors JS and MK contributed to the conception and design of the article, including investigations and image formatting for the preparation of the case report. Images were provided by MK and MT. The article was drafted by JS and revised by MK, RP and MT. The final approval of the submitted version for publication was approved by all authors.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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