Esophageal perforation during laparoscopic sleeve gastrectomy: Complication of bougie insertion

INTRODUCTION AND IMPORTANCE

Esophageal perforation (EF) is an uncommon complication of bariatric procedures, mostly related to the intraoperative use of bougie that is used for gastric calibration.

CASE PRESENTATION

Here, we present a 33-year-old woman who underwent laparoscopy sleeve surgery (LSG). Due to perforation in the cervical site of the esophagus caused by bougie insertion, she developed subcutaneous emphysema on the first post-operative day. She immediately underwent reconstructive esophageal surgery under the probable diagnosis of having a cervical esophagus perforation. The patient's condition was stable in the postoperative period and discharged after 10 days.

CLINICAL DISCUSSION

The patients who present symptoms including subcutaneous emphysema, cervical pain, dysphagia, dysphonia, and fever post-surgery have to be considered for probably EF. The early optimal diagnosis works up and therapeutic approach should be performed as soon as possible to prevent mortality.

CONCLUSION

EP caused by a bougie insertion is an uncommon complication that is associated with high mortality rates if the diagnosis and treatment were delayed. The risk of using a bougie during surgery should not be underestimated and have to be inserted with extreme caution and careful guide of surgeon.

Late Gastropleural Fistula after the Management of Laparoscopic Sleeve Gastrectomy Leakage

One of the rare but serious complications of laparoscopic sleeve gastrectomy (LSG) with significant morbidity and mortality is gastropleural fistula (GPF). Here, we present a 34-year-old woman who underwent LSG. Due to leakage in the proximal site of the stapler line and splenic artery erosion into the site of leakage after 1 month, splenectomy and drainage catheter insertion was done. Three months later, she presented with dyspnea, fever, and lung abscess, GPF was diagnosed, and Roux-en-Y fistulo-jejunostomy was done. After 10 days, her clinical condition improved, but the patient expired due to hemorrhagic cerebrovascular accident (CVA). Therefore, GPF along with other common complications should be seriously considered in patients developing post-LSG chronic respiratory symptoms.