A woman in her 70s was referred to our institution with upper gastrointestinal (GI) bleeding 3 months after a Toupet fundoplication with anterior gastropexy, performed due to gastro-oesophageal reflux disease and a large paraoesophageal hernia. Clinical investigation revealed two ulcers, with one of them at the gastropexy site. A couple of weeks later, the patient presented with a gastrocutaneous fistula. Failure of conservative and endoscopic treatment of the fistula and GI bleeding demanded surgical treatment. The gastropexy tissue was excised and bleeding from the left superior epigastric artery, involved at the ulcerated gastropexy site, was identified; a definitive surgical repair was performed at a second stage. This is an extremely rare complication of anterior gastropexy and bleeding from the gastropexy site, especially when refractory to endoscopic treatment, should raise suspicion for involvement of superior left epigastric artery. The timing of the definitive surgical repair might be of major relevance.
- GI bleeding
- Gastro-oesophageal reflux
- Stomach wall
- Gastrointestinal surgery
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Contributors PA-F is the primary author, responsible for literature research and writing the manuscript; JBP was the second reviewer and revised the manuscript as well as HKA, as third reviewer. The authors read and approved the final manuscript.
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.
Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.