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Basahai I, Alzeer MA, Almuhanna BS. Successful treatment of gastric bleeding caused by left phrenic artery pseudoaneurysm post-surgery with endovascular embolization: A case report. Radiol Case Rep 2024; 19:2351-2356. [PMID: 38532908 PMCID: PMC10963892 DOI: 10.1016/j.radcr.2024.02.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/18/2024] [Accepted: 02/25/2024] [Indexed: 03/28/2024] Open
Abstract
Pseudoaneurysms are rare but potentially life-threatening complications that may occur after surgical procedures. This report presents the case of a 28-year-old woman who developed a pseudoaneurysm in the Left Inferior Phrenic Artery (LIPA) following a Laparoscopic Sleeve Gastrectomy (LSG). The complication manifested as severe gastrointestinal bleeding. Upper GI Endoscopy and multislice CT scan, repeated twice, failed to localize the bleeding source to treat it. Successful endovascular embolization using a Glue/Lipidol mixture was achieved despite difficulties in localizing the pseudoaneurysm, resulting in immediate symptomatic relief and avoiding surgical intervention. This case shows the importance of prompt identification and management of LIPA pseudoaneurysms following LSG, highlighting the importance of early diagnosis to prevent further hemodynamic deterioration and other adverse outcomes.
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Affiliation(s)
- Izzat Basahai
- Consultant Interventional Radiologist, King Khalid University Hospital, Department of Radiology, King Saud University, Riyadh, Saudi Arabia
| | - Meshari A. Alzeer
- MBBS, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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2
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Kitaghenda FK, Shu C, Wang J, Hong J, Yao L, Zhu X. Measurement of gastric wall thickness after laparoscopic sleeve gastrectomy: obesity comorbidities and gastric wall in Chinese patients with obesity. Updates Surg 2023:10.1007/s13304-023-01538-z. [PMID: 37258849 DOI: 10.1007/s13304-023-01538-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/10/2023] [Indexed: 06/02/2023]
Abstract
Leakage of the sleeve remains constant after laparoscopic sleeve gastrectomy (LSG). This complication may be due to a mismatch between the staple height and gastric wall thickness (GWT). Our aim was to measure the GWT in Chinese patients with obesity and investigate the relationship between GWT and gender, body mass index (BMI), body weight, and obesity-related comorbidities. The GWT of 210 resected specimens after LSG was measured using a tissue measuring device, at a compression pressure of 8 g/mm2 at three predetermined locations: antrum, midbody, and fundus. Two hundred ten patients (171 female/39 male). The gastric wall was thickest at the antrum followed by the midbody and thinnest at the fundus (3.02 mm, 2.22 mm, and 1.6 mm, respectively). Patients with gastritis and those with reflux esophagitis had thicker GWT at the antrum; male had thicker GWT at the antrum and fundus; patients with body weight > 100 kg, and those with BMI > 40 kg/m2 had thicker GWT at the fundus. Linear regression analysis revealed a significant association between GWT with body weight and BMI at the antrum and fundus; Furthermore, hypertension associated with the GWT at the fundus (P < 0.01, P < 0.01, P < 0.02, P < 0.01; and P < 0.04, respectively). This study showed that the anatomical location of the gastric wall is a major predicting factor of GWT. Furthermore, gastritis, reflux esophagitis, male gender, BMI > 40 kg/m2, body weight > 100 kg, and hypertension may increase the GWT at the antrum and fundus in Chinese patients with obesity.
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Affiliation(s)
- Fidele Kakule Kitaghenda
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, Jiangsu, People's Republic of China
| | - Chang Shu
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, Jiangsu, People's Republic of China
| | - Jian Wang
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, Jiangsu, People's Republic of China
| | - Jian Hong
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, Jiangsu, People's Republic of China
| | - Libin Yao
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, Jiangsu, People's Republic of China.
| | - Xiaocheng Zhu
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, Jiangsu, People's Republic of China.
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3
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Smith SA, Auld M, Ogg M, Chandrasegaram MD. Open splenic artery aneurysm repair in a patient with previous laparoscopic sleeve gastrectomy. BMJ Case Rep 2022; 15:e250082. [PMID: 36423939 PMCID: PMC9693678 DOI: 10.1136/bcr-2022-250082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We present the case of a female patient in her 40s who underwent a splenic artery aneurysm (SAA) repair following a previous laparoscopic sleeve gastrectomy (SG). We aim to discuss the management approach to SAAs and considerations in the setting of previous bariatric surgery.The patient consented to this case report. We include preoperative and postoperative radiological images and intraoperative images.While pseudoaneurysms following bariatric surgery have been reported, we present a case of a likely true SAA following SG. Our experience may assist others who come across similar cases in the future.
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Affiliation(s)
- Sonya Ann Smith
- General Surgery, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Michael Auld
- General Surgery, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Murray Ogg
- Vascular Surgery, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Manju Dashini Chandrasegaram
- General Surgery, The Prince Charles Hospital, Chermside, Queensland, Australia
- Northside Clinical School, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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4
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Sasaki T, Ishibashi Y, Hatao F, Kawasaki K, Yamazaki R, Morita Y, Imamura K. A case of late postoperative intra-abdominal hemorrhage developing 13 months after laparoscopic sleeve gastrectomy. Asian J Endosc Surg 2022; 15:184-187. [PMID: 34089290 DOI: 10.1111/ases.12958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 11/26/2022]
Abstract
A 29-year-old male patient underwent laparoscopic sleeve gastrectomy (LSG) for morbid obesity and was discharged without any complications. Thirteen months later, he visited the emergency room with epigastric pain. A few hours before onset, he had had a larger-than-usual meal and vomited afterwards. Enhanced abdominal computed tomography revealed a hematoma 127 × 63 mm in diameter around the stomach. Angiography revealed no extravasation or pseudoaneurysm. Upper gastrointestinal endoscopy found no ulcers or abnormality of the stapler line scar from the LSG. The patient's vital signs were stable, and his hemoglobin had not fallen below the previous day's value. Conservative treatment was therefore chosen. The patient was discharged in stable condition after 11 days of hospitalization. However, the exact source of the hemorrhage was unable to be detected on the imaging findings. In view of his clinical course and the hematoma location, omental vessels were suspected of being the source of the hemorrhage.
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Affiliation(s)
- Takayoshi Sasaki
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan
| | - Yuji Ishibashi
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan
| | - Fumihiko Hatao
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan
| | - Koichiro Kawasaki
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan
| | - Ryoto Yamazaki
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan
| | - Yasuhiro Morita
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan
| | - Kazuhiro Imamura
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan
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5
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Najjari K, Talebpour M, Amirbeigi A. Ruptured Splenic Artery Pseudoaneurysm 3 Years After Laparoscopic Sleeve Gastrectomy. Obes Surg 2021; 31:4185-4187. [PMID: 34033011 DOI: 10.1007/s11695-021-05479-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 05/09/2021] [Accepted: 05/13/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Khosrow Najjari
- Department of General Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Talebpour
- Department of General Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Amirbeigi
- Department of General Surgery, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
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6
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Rebibo L, Tricot M, Dembinski J, Dhahri A, Brazier F, Regimbeau JM. Gastric leak after sleeve gastrectomy: risk factors for poor evolution under conservative management. Surg Obes Relat Dis 2021; 17:947-955. [PMID: 33640258 DOI: 10.1016/j.soard.2021.01.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/16/2020] [Accepted: 01/21/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Gastric leak (GL) is the most highly feared early postoperative complication after sleeve gastrectomy (SG), with an incidence of 1% to 2%. This complication may require further surgery/endoscopy, with a risk of management failure that may require additional surgery, including total gastrectomy, leading to a risk of mortality of 0% to 9%. OBJECTIVES Assess the impact of factors that may lead to a poorer evolution of GL. SETTING University Hospital, France, public practice. METHODS This was a retrospective, single-center study of a group of patients managed for GL after SG between November 2004 and January 2019 (n = 166). Forty-three patients were excluded. The population study was divided into 2 groups: patients with easy closing of the GL (n = 73) and patients with difficult closing of the GL or failure to heal (n = 50). Patients were allocated to 1 of 2 groups depending on the time to heal (median time of 84 days). The study's primary efficacy endpoint was to determine the risk factors for a poorer evolution of GL. RESULTS Among 123 patients included in this study, 103 patients had undergone primary SG (83.7%). The mean time to the appearance of GL was 15.1 days (range, 1-156 d). Seventy-four patients underwent a reoperation (60%). The mean number of endoscopies per patient was 2.7 (range, 2-7 endoscopies). The mean time to healing was 89.5 days (range, 18-386 d). There were 8 cases of healing failure (6.5%). Multivariate analysis identified body mass index (>47 kg/m2), time to referral (>2 d), and serum prealbumin level (<.1 g/dL) to be independent risk factors for a poorer evolution of GL. CONCLUSION Improvement of nutritional status before SG and early referral for GL could reduce the risk of delayed closure or the need for further surgery.
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Affiliation(s)
- Lionel Rebibo
- Department of Digestive, Esogastric, and Bariatric Surgery, Bichat Claude Bernard University Hospital, Paris, France; Université de Paris, Inserm UMR 1149 F-75018 Paris, France
| | - Meghane Tricot
- Department of Digestive Surgery, Amiens University Medical Center, Amiens, France
| | - Jeanne Dembinski
- Department of Digestive Surgery, Amiens University Medical Center, Amiens, France
| | - Abdennaceur Dhahri
- Department of Digestive Surgery, Amiens University Medical Center, Amiens, France
| | - Franck Brazier
- Department of Hepato-Gastroenterology, Amiens University Medical Center, Amiens, France
| | - Jean-Marc Regimbeau
- Department of Digestive Surgery, Amiens University Medical Center, Amiens, France; Simplification of Surgical Patient Care Clinical Research Unit, University of Picardie Jules Verne, Amiens, France.
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7
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Pseudoaneurysm of the Splenic Artery Following Bariatric Surgery. Obes Surg 2021; 31:2295-2297. [PMID: 33405183 DOI: 10.1007/s11695-020-05146-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/24/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
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8
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Left gastric artery pseudo-aneurysm post sleeve gastrectomy: A case report. Int J Surg Case Rep 2020; 76:183-185. [PMID: 33038844 PMCID: PMC7550829 DOI: 10.1016/j.ijscr.2020.09.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 11/22/2022] Open
Abstract
Bleeding in the context of sleeve gastrectomy could be caused by a variety of diseases. Pseudo-aneurysm is an overlooked complication. Angiography followed by embolization is best for diagnosing and treating. Common risk factors for pseudo-aneurysm include, infection, trauma, neoplasm, inflammation and surgery. Treatment was surgical, this case was treated by interventional radiology.
Introduction Bleeding in the context of sleeve gastrectomy could be caused by a variety of diseases however pseudo-aneurysm is an overlooked complication. Case For instance, we present case of a 25 year-old Lebanese woman that undergone sleeve gastrectomy and presented 3 weeks later with a bleeding left gastric artery pseudo-aneurysm. Conclusion Angiography followed by embolization is best for diagnosing and treating the pseudo-aneurysm by coiling. Serious outcomes could arise from such a complication. Hence, accurate diagnosis and treatment using the appropriate methods is essential to avoid life-threatening events.
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Davrieux CF, Palermo M, Cúneo T, Zanutini D, Giménez ME. What is the Role of Image-Guided Endovascular Surgery in Postbariatric Surgery Bleeding Complications? J Laparoendosc Adv Surg Tech A 2020; 31:146-151. [PMID: 32936031 DOI: 10.1089/lap.2020.0696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Obesity treatment requires surgical procedures included in bariatric surgery. Bleeding complications are reported in 1%-4%. Image-guided surgery (IGS) includes minimally invasive procedures that have the advantage of less aggression to the patient, fewer complications, and a quick recovery. Endovascular therapy by interventional radiology (IR) is a minimally invasive image-guided procedure widely used in central, peripheral, and splanchnic vascular pathology. Treatment of postoperative bleeding in bariatric surgery can be aided by image-guided endovascular procedures. Objectives: The aim of this study is to carry out an update on the application of IR in bariatric surgery bleeding complications. Bleeding Complications: General rate of postoperative complications in bariatric surgery is 0%-10%. Postoperative bleeding (1%-4%) can be gastrointestinal (endoscopic treatment) or intra-abdominal (surgical treatment/relaparoscopy). In the case of arterial vascular lesions that cannot be resolved either endoscopically or surgically, the option of endovascular treatment with IR should be considered. Conclusions: Endovascular approach through IR and IGS in bleeding complications after bariatric surgery is presented as a valid minimally invasive therapy option in this group of patients.
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Affiliation(s)
- Carlos Federico Davrieux
- DAICIM Foundation (Teaching, Research, Assistance in Minimal Invasive Surgery), Buenos Aires, Argentina.,Department of Surgery, Sanatorio de la Mujer, Rosario, Argentina
| | - Mariano Palermo
- DAICIM Foundation (Teaching, Research, Assistance in Minimal Invasive Surgery), Buenos Aires, Argentina.,Department of Bariatric Surgery, Diagnomed, Buenos Aires, Argentina.,School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Tomás Cúneo
- Department of Interventional Radiology, Sanatorio Británico, Rosario, Argentina
| | - Daniel Zanutini
- Department of Interventional Radiology, Sanatorio Británico, Rosario, Argentina
| | - Mariano E Giménez
- DAICIM Foundation (Teaching, Research, Assistance in Minimal Invasive Surgery), Buenos Aires, Argentina.,School of Medicine, University of Buenos Aires, Buenos Aires, Argentina.,IRCAD (Institute for Research on Cancer of the Digestive System), Strasbourg, France.,IHU-Strasbourg (Hospital-University Institute), Strasbourg, France
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10
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Peters L, Zhao J, Makanyengo S, Pockney P. Delayed Splenic Artery Pseudoaneurysm After Laparoscopic Sleeve Gastrectomy. Obes Surg 2020; 31:872-874. [PMID: 32808170 DOI: 10.1007/s11695-020-04914-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/02/2020] [Accepted: 08/10/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Luke Peters
- Surgical Services, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW, Australia. .,Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.
| | - Jie Zhao
- Surgical Services, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW, Australia.,Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Samwel Makanyengo
- Surgical Services, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW, Australia.,Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Peter Pockney
- Surgical Services, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW, Australia.,Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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11
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Shen Y, Liu Y, Zheng SQ, Han J, Pei EL, Li ZH, Xie XY, Li ZQ, Luo M. Effects of Left Gastric Artery Ligation Versus Sleeve Gastrectomy on Obesity-Induced Adipose Tissue Macrophage Infiltration and Inflammation in Diet-Induced Obese Rats. Med Sci Monit 2019; 25:6719-6726. [PMID: 31493329 PMCID: PMC6752093 DOI: 10.12659/msm.915532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Bariatric procedures such as left gastric artery ligation (LGAL) and sleeve gastrectomy (SG) have emerged as important procedures for treating morbid obesity. In this study, we compared the effects of LGAL vs. SG on obesity-induced adipose tissue macrophage infiltration and inflammation in diet-induced obese rats. Material/Methods Sprague-Dawley (SD) rats were fed a high-fat diet (HFD) for 16 weeks to induce obesity. SG, GLAL, or corresponding sham surgeries were performed in anesthetized rats. Inflammatory factor expression in serum and epididymal and retroperitoneal adipose tissues were analyzed 4 weeks after surgery. Macrophage infiltration and phenotype transformation were also assessed with Western blot analysis and immunofluorescence. Results Both LGAL and SG strongly attenuated high-fat diet (HFD)-induced fat accumulation in retroperitoneal and epididymal tissues. The expressions of inflammatory cytokines such as tumor necrosis factor (TNF)-agr;, interleukin (IL)-6, and monocyte chemoattractant protein (MCP)-1 were downregulated after LGAL and after SG by promoting activation of M2 macrophages, despite continued exposure to HFD. Furthermore, both LGAL and SG resulted in increased macrophage infiltration, but did not contribute to phenotype transformation of macrophages to M1. Conclusions LGAL and SG both reduced fat accumulation caused by HFD feeding. Therapies designed to ameliorate the inflammatory response by promoting activation of M2 macrophages may be valuable.
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Affiliation(s)
- Yi Shen
- Department of Geriatrics, Tongji Hospital, Tongji University, School of Medicine, Shanghai, China (mainland)
| | - Yang Liu
- Department of Geriatrics, Tongji Hospital, Tongji University, School of Medicine, Shanghai, China (mainland)
| | - Shao-Qiu Zheng
- Department of Interventional and Vascular Surgery, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China (mainland)
| | - Jiang Han
- Division of General Surgery, Pudong New Area District Zhoupu Hospital, Shanghai, China (mainland)
| | - Er-Li Pei
- Department of General Surgery, Yangpu Hospital Affiliated to Shanghai Tongji University School of Medicine, Shanghai, China (mainland)
| | - Zhi-Hong Li
- Division of General Surgery, Pudong New Area District Zhoupu Hospital, Shanghai, China (mainland)
| | - Xiao-Yun Xie
- Department of Interventional and Vascular Surgery, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China (mainland)
| | - Zhi-Qiang Li
- Department of Neurology, Shanxi Academy of Medical Sciences, Shanxi Dayi Hospital, Taiyuan, Shanxi, China (mainland)
| | - Ming Luo
- Department of Geriatrics, Tongji Hospital, Tongji University, School of Medicine, Shanghai, China (mainland)
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12
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Foltz G, Khaddash T. Embolization of Nonvariceal Upper Gastrointestinal Hemorrhage Complicated by Bowel Ischemia. Semin Intervent Radiol 2019; 36:76-83. [PMID: 31123376 DOI: 10.1055/s-0039-1688419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Over the past three decades, transcatheter arterial embolization has become the first-line therapy for the management of acute nonvariceal upper gastrointestinal bleeding refractory to endoscopic hemostasis. Overall, transcatheter arterial interventions have high technical and clinical success rates. This review will focus on patient presentation and technical considerations as predictors of complications from transcatheter arterial embolization in the management of acute upper gastrointestinal hemorrhage.
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Affiliation(s)
- Gretchen Foltz
- Section of Interventional Radiology, Department of Radiology, Washington University St. Louis - School of Medicine, St. Louis, Missouri
| | - Tamim Khaddash
- Section of Interventional Radiology, Department of Radiology, Washington University St. Louis - School of Medicine, St. Louis, Missouri
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13
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Montana L, Genser L, Cortes A, Poupardin E, Barrat C, Carandina S. Gastrosplenic Fistula with Gastrointestinal Bleeding: a Rare and Potentially Fatal Complication After Sleeve Gastrectomy. Obes Surg 2018; 28:2135-2139. [DOI: 10.1007/s11695-018-3284-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Ball JF, Sreedharan L, Reddy S, Tan B, Sujendran V. Splenic artery pseudoaneurysm causing delayed gastrointestinal bleeding after gastrocolonic fistula following sleeve gastrectomy. Ann R Coll Surg Engl 2017; 100:e15-e17. [PMID: 29046081 DOI: 10.1308/rcsann.2017.0179] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Delayed gastrointestinal bleeding in the context of a gastric fistula is a very rare complication of longitudinal sleeve gastrectomy. We report the case of a patient who presented with massive gastrointestinal bleeding from a pseudoaneurysm arising from the splenic artery following complications after a longitudinal sleeve gastrectomy several months previously. The case was successfully managed with angiographic embolisation and we present our experience with recommendations for managing this rare but life-threatening complication.
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Affiliation(s)
- J F Ball
- Hospital Universitario de la Princesa , Madrid , Spain
| | - L Sreedharan
- Hospital Universitario de la Princesa , Madrid , Spain
| | - S Reddy
- Hospital Universitario de la Princesa , Madrid , Spain
| | - Bhl Tan
- Hospital Universitario de la Princesa , Madrid , Spain
| | - V Sujendran
- Hospital Universitario de la Princesa , Madrid , Spain
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15
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ACR Appropriateness Criteria ® Nonvariceal Upper Gastrointestinal Bleeding. J Am Coll Radiol 2017; 14:S177-S188. [PMID: 28473074 DOI: 10.1016/j.jacr.2017.02.038] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 02/20/2017] [Accepted: 02/21/2017] [Indexed: 12/18/2022]
Abstract
Upper gastrointestinal bleeding (UGIB) remains a significant cause of morbidity and mortality with mortality rates as high as 14%. This document addresses the indications for imaging UGIB that is nonvariceal and unrelated to portal hypertension. The four variants are derived with respect to upper endoscopy. For the first three, it is presumed that upper endoscopy has been performed, with three potential initial outcomes: endoscopy reveals arterial bleeding source, endoscopy confirms UGIB without a clear source, and negative endoscopy. The fourth variant, "postsurgical and traumatic causes of UGIB; endoscopy contraindicated" is considered separately because upper endoscopy is not performed. When endoscopy identifies the presence and location of bleeding but bleeding cannot be controlled endoscopically, catheter-based arteriography with treatment is an appropriate next study. CT angiography (CTA) is comparable with angiography as a diagnostic next step. If endoscopy demonstrates a bleed but the endoscopist cannot identify the bleeding source, angiography or CTA can be typically performed and both are considered appropriate. In the event of an obscure UGIB, angiography and CTA have been shown to be equivalent in identifying the bleeding source; CT enterography may be an alternative to CTA to find an intermittent bleeding source. In the postoperative or traumatic setting when endoscopy is contraindicated, primary angiography, CTA, and CT with intravenous contrast are considered appropriate. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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16
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Rebibo L, Bartoli E, Dhahri A, Cosse C, Robert B, Brazier F, Pequignot A, Hakim S, Yzet T, Delcenserie R, Dupont H, Regimbeau JM. Persistent gastric fistula after sleeve gastrectomy: an analysis of the time between discovery and reoperation. Surg Obes Relat Dis 2016; 12:84-93. [DOI: 10.1016/j.soard.2015.04.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 04/12/2015] [Accepted: 04/19/2015] [Indexed: 01/08/2023]
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17
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Division of the stomach and checking haemostasis for performing sleeve gastrectomy. Points of controversy. Obes Surg 2015; 25:537-8. [PMID: 25218015 DOI: 10.1007/s11695-014-1439-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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18
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19
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Barreca M, Nagliati C, Jain VK, Whitelaw DE. Combined endoscopic-laparoscopic T-tube insertion for the treatment of staple-line leak after sleeve gastrectomy: a simple and effective therapeutic option. Surg Obes Relat Dis 2014; 11:479-82. [PMID: 25733002 DOI: 10.1016/j.soard.2014.12.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 12/14/2014] [Accepted: 12/15/2014] [Indexed: 01/14/2023]
Abstract
BACKGROUND Management of staple-line leak after laparoscopic sleeve gastrectomy (LSG) remains controversial and matter of debate. Transforming a leak into a controlled fistula by insertion of a T-tube is a viable option. To minimize surgical dissection, and to facilitate identification of the leak site and insertion of the T-tube, we have developed a combined endoscopic-laparoscopic T-tube (ELT-t) insertion technique. METHODS Between February 2011 and June 2014, 7 patients presented with staple-line leak and were treated with ELT-t insertion. After laparoscopic dissection of the abscess cavity, a guidewire is passed endoscopically through the leak; a polypectomy snare is anchored to the guidewire and retrieved through the patient mouth. The long arm of a T-tube is eventually secured to the snare and pulled down through the leak. RESULTS All patients were started on oral feeding with the T-tube in place. Serial water-soluble contrast swallows were performed to check for healing, and the T-tube was clamped as soon as no extravasation of contrast was demonstrated. The tube was removed either during the index admission or in the outpatient clinic. The residual fistula closed successfully after T-tube removal in all but one case with a "spiral-shaped" sleeve and functional distal obstruction. This patient was treated with stent. Patients were discharged home after a mean postoperative hospital stay of 53.3 days (range: 15-87 days). CONCLUSION In our experience, ELT-t is a valid alternative for the treatment of staple-line leak after LSG. It allows minimizing surgical dissection, and appears to be safe and effective.
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Affiliation(s)
- Marco Barreca
- Department of Surgery, Luton & Dunstable University Hospital, NHS FT.
| | - Carlo Nagliati
- Department of Surgery, Luton & Dunstable University Hospital, NHS FT
| | - Vigyan K Jain
- Department of Surgery, Luton & Dunstable University Hospital, NHS FT
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Laparoscopic sleeve gastrectomy as day-case surgery (without overnight hospitalization). Surg Obes Relat Dis 2014; 11:335-42. [PMID: 25614354 DOI: 10.1016/j.soard.2014.08.017] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Revised: 08/15/2014] [Accepted: 08/29/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND Day-case surgery (DCS) has boomed over recent years, as has laparoscopic sleeve gastrectomy (SG) for the treatment of morbid obesity. The objective of this study was to evaluate the safety and feasibility of day-case SG. METHODS This was a prospective, nonrandomized study of 100 patients undergoing day-case SG from May 2011 to July 2013. All patients met the criteria for DCS and for the treatment of morbid obesity. Standard surgical, anesthetic, and analgesic protocols were used. The primary study endpoint was the unplanned overnight admission rate. Secondary endpoints were standard DCS criteria, frequency and type of complications, and satisfaction rate of performing day-case SG. The short-term postoperative course of patients undergoing day-case and conventional SG also were compared. RESULTS A total of 416 patients were screened and 100 (24%) were included. There were 8 unplanned overnight admissions. Seven unexpected consultations, 7 hospital readmissions, and 5 major complications were recorded, including 3 cases of unexpected surgery for gastric leak. At follow-up, 96% of the patients were satisfied with day-case SG. The short-term postoperative course was similar among patients undergoing DCS and conventional management. CONCLUSION In selected patients, day-case SG is feasible with acceptable complication and readmission rates. The postoperative course was similar to that observed for standard SG.
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Rebibo L, Dhahri A, Berna P, Yzet T, Verhaeghe P, Regimbeau JM. Management of gastrobronchial fistula after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 2014; 10:460-7. [DOI: 10.1016/j.soard.2013.08.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 07/23/2013] [Accepted: 08/07/2013] [Indexed: 12/19/2022]
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Chen RZ, Zhao G, Jin N, Chen BA, Ding JH. Superselective arterial embolization of the superior mesenteric artery for the treatment of gastrointestinal hemorrhage following allogeneic hematopoietic stem cell transplantation. Patient Prefer Adherence 2014; 8:1581-5. [PMID: 25419120 PMCID: PMC4235499 DOI: 10.2147/ppa.s72875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Superselective arterial embolization is a common therapeutic procedure for cases of visceral hemorrhage. However, until now, it has not been applied in the treatment of gastrointestinal (GI) hemorrhage caused by acute graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation. We describe a case presenting with persistent GI bleeding associated with acute GVHD successfully treated by superselective arterial embolization of the superior mesenteric artery with gelatin sponge after noneffective conventional management. This case will help guide hematologists to deal with a similar situation in the future.
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Affiliation(s)
- Run-Zhe Chen
- Department of Hematology and Oncology, Key Department of Jiangsu Medicine, Zhongda Hospital, Medical School, Southeast University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Gang Zhao
- Department of Hematology and Oncology, Key Department of Jiangsu Medicine, Zhongda Hospital, Medical School, Southeast University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Nan Jin
- Department of Hematology and Oncology, Key Department of Jiangsu Medicine, Zhongda Hospital, Medical School, Southeast University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Bao-An Chen
- Department of Hematology and Oncology, Key Department of Jiangsu Medicine, Zhongda Hospital, Medical School, Southeast University, Nanjing, Jiangsu Province, People’s Republic of China
- Correspondence: Bao-An Chen, Department of Hematology and Oncology, Zhongda Hospital, Medical School, Southeast University, Dingjiaqiao 87, Gulou District, Nanjing 210009, Jiangsu Province, People’s Republic of China, Tel +86 25 83 27 2006, Fax +86 25 83 27 2011, Email
| | - Jia-Hua Ding
- Department of Hematology and Oncology, Key Department of Jiangsu Medicine, Zhongda Hospital, Medical School, Southeast University, Nanjing, Jiangsu Province, People’s Republic of China
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Bartoli E, Rebibo L, Robert B, Fumery M, Delcenserie R, Regimbeau JM. Efficacy of the double-pigtail stent as a conservative treatment for grade B pancreatic fistula after pancreatoduodenectomy with pancreatogastric anastomosis. Surg Endosc 2013; 28:1528-34. [PMID: 24337192 DOI: 10.1007/s00464-013-3347-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 11/18/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Despite improvements in surgical techniques and postoperative care, morbidity associated with pancreatoduodenectomy (PD) is still high. Grade B pancreatic fistula (PF) requires a specific combination of radiologically guided external drainage and medical support. This treatment is effective but requires prolonged hospitalization and maintenance of external drainage. The objective of this study was to evaluate the feasibility and efficacy of a double-pigtail stent (DPS) to treat grade B PF after PD with pancreatogastric anastomosis. METHODS Between January 2008 and October 2011, all patients who presented grade B PF after PD (n = 6) were included in the study. The PF was diagnosed according to the criteria of the International Study Group on Pancreatic Fistula. Endoscopic treatment was standardized with a DPS. The primary efficacy end point was the feasibility and efficacy of DPS placement. Secondary end points included data on the PF, the DPS placement procedure, and long-term outcome. RESULTS Endoscopic DPS placement was achieved in all patients with no complications. The median time to onset of PF after PD was 14 days. Closure of the external PF was obtained 7 days after the introduction of the DPS. The median time to external drain removal was 7 days after DPS placement, and the median time to oral refeeding was 7 days after DPS placement for all patients. The median time to DPS removal was 60 days. The median length of hospital stay after DPS placement was 10 days. During a median follow-up period of 21 months, there was no recurrence of PF after removal of the DPS. CONCLUSION Endoscopic treatment of grade B PF after PD appears to be effective and safe and is associated with shorter hospitalization.
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Affiliation(s)
- Eric Bartoli
- Department of Gastroenterology, Amiens University Medical Center and the Jules Verne University of Picardie, Amiens, France
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Letter to Editor: “Gastric Fistula after Laparoscopic Sleeve Gastrectomy: Don't Forget to Treat for Candida”. Obes Surg 2013; 23:2106-8. [DOI: 10.1007/s11695-013-1052-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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