*A 46 year-old woman presented with upper quadrant abdominal pain, fever and vomiting.
What is the most likely diagnosis?
1. Gastrointestinal Perforation
2. Stomach strictures
3. Staple line leak after sleeve gastrectomy procedure
4. Intraperitoneal bleeding
Answer
Case Discussion:
The Abdomen CT shows staple line and extravasation of oral contrast material around the stomach.
Laparoscopic sleeve gastrectomy (LSG), also known as the gastric sleeve resection, has become a standard procedure for the surgical treatment of patients with different degrees of obesity. In this operation, approximately 90% of the stomach is removed to reduce its capacity to around 100 to 200mL. Clinical advantages of this procedure include rapid and reliable weight loss, decreased risk of late bowel obstruction and internal herniation, reduced risk of slippage and erosion due to the lack of a foreign body (unlike the gastric band procedure).
However this procedure causes three important adverse effects:
1. Bleeding
2. Strictures, usually at the middle or distal part of the residual stomach
3. Staple line leaks which cause the highest morbidity.
The treatment for leaks after sleeve gastrectomy varies and depends upon the degree of disruption, the size of abdominal contamination, and the position of the leak (proximal versus distal).
References:
1. Barreto TW, Kemmeter PR, Paletta MP, Davis AT. A Comparison of a Single Center’s Experience with Three Staple Line Reinforcement Techniques in 1,502 Laparoscopic Sleeve Gastrectomy Patients. Obes Surg. 2014 Sep 12. [Epub ahead of print] PubMed PMID: 25214203.
2. D’Ugo S, Gentileschi P, Benavoli D, Cerci M, Gaspari A, Berta RD, Moretto C, Bellini R, Basso N, Casella G, Soricelli E, Cutolo P, Formisano G, Angrisani L, Anselmino M. Comparative use of different techniques for leak and bleeding prevention during laparoscopic sleeve gastrectomy: a multicenter study. Surg Obes Relat Dis. 2014 May-Jun;10(3):450-4. doi: 10.1016/j.soard.2013.10.018. Epub 2013 Nov 12. PubMed PMID: 24448100