Fistulojejunostomy for Unsuccessful Endoscopic Treatment of a Case of Chronic Gastrocutaneous Fistula Caused by Sleeve Gastrectomy

Currently, sleeve gastrectomy (SG) is a surgical procedure performed for the treatment of obesity. Post-operative leakage is considered a rare but devastating complication of this surgery, with an incidence of gastric leakage and fistula after sleeve gastrectomy ranging from 1 to 2.4%. Most cases respond well to supportive treatment and rarely require surgery. This research presents a rare case of gastrocutaneous fistula caused by sleeve surgery, which did not respond to supportive treatment and ultimately required fistulogenostomy.
The research was approved by the Research Ethics Board of the University, with the ethics code IR.AJUMS.HGOLESTAN.REC.1402.466. A 30-year-old female patient who underwent sleeve gastrectomy surgery experienced severe epigastric pain two days post-operation and was admitted to the hospital five days later. Endoscopic findings revealed a large defect filled with pus at the site of the previous sleeve. Initially, collection drainage was performed under CT scan guidance, followed by the placement of a Double Pigtail Stent in the leakage area. As the patient did not respond to supportive and endoscopic treatments, laparotomy fistulojejunostomy and jejunostomy tube insertion were performed with a diagnosis of gastroesophageal junction (GEJ) leakage. Following the operation, the patient was transferred to the special care department of the hospital. The day after the procedure, the patient was conscious with stable vital signs and showed no signs of bleeding, hemoglobin drop, or sepsis. One week later, the patient was discharged in good general condition with the necessary recommendations. This study highlights the importance of considering surgical treatments for gastrocutaneous fistulas caused by sleeve surgery if they do not respond well to supportive and endoscopic interventions