Development of a Gastric Pouch-Aorto-Colic Fistula as a Complication of a Revisionary Open Roux-en-Y Gastric Bypass |
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Authors: | Mario Raul Villalba Mario Ramon Villalba |
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Institution: | (1) Department of General Surgery, William Beaumont Hospital, 3601 West Thirteen Mile Road, Royal Oak, MI 48073, USA;(2) Surgical Critical Care, William Beaumont Hospital, 3601 West Thirteen Mile Road, Royal Oak, MI 48073, USA;(3) 3535 W. 13 Mile Rd., Suite 501 Medical Office Building, Royal Oak, MI 48073, USA |
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Abstract: | A 45-year-old female presented with an enterocutaneous fistula and intraabdominal abscesses weeks after undergoing an open
roux-en-y gastric bypass 20 years after a previous bariatric procedure. Initial management consisted of exploration with resection
of the fistula, open abscess drainage, percutaneous drains, and culture-directed intravenous antibiotics. Months later, the
patient developed a gastrocolic fistula and massive upper gastrointestinal bleeding from a gastro-aortic fistula. The patient
underwent resection of the gastrocolic fistula followed by a damage control operation including a left thoracotomy with aortic
cross-clamping for the gastro-aortic fistula. Final reconstruction necessitated an extra-anatomic opening in the diaphragm
for creation of an intrathoracic esophagojejunostomy and marsupialization of the distal esophagus and gastric pouch with concomitant
mucusectomy. This rare but devastating complication requires prompt surgical management. In the appropriate setting, a high
suspicion must be maintained in order to act swiftly for the patient’s benefit
Neither author has any commercial interest to disclose. |
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Keywords: | Roux-en-Y gastric bypass Massive gastrointestinal bleed Gastro-aortic fistula Intraabdominal sepsis Gastrocolic fistula |
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