Endoscopic Treatment of Anastomotic Leakage Following Sleeve Gastrectomy: A Case Report

Abstract

Background and purpose: Bariatric surgeries are effective treatments for morbid obesity, among which sleeve gastrectomy (SG) has become more popular. One of the most serious complications of this method is anastomosis leak which is treated by reoperation or endotherapy. The use of clips is recently proposed as a safe and effective option for treatment of leaks following bariatric surgeries. This article presents the case of a woman with sepsis following sleeve gastrectomy who was diagnosed with anastomosis leak. A 57 year -old woman weighing 140 kg (BMI: 54.6) underwent sleeve gastrectomy due to menopause obesity and sleep apnea. She had abdominal pain, fever, and leukocytosis following surgery. With suspicion of surgical complications, the patient underwent gastrografin study and leakage was seen at the junction of cardia and fundus. Oral feeding stopped immediately and intravenous antibiotics started. Then, signs of sepsis were seen and the patient underwent upper GI endoscopy and the fistula was closed using an Ovesco clip. She was discharged four days later in good general situation. Anastomosis leak is a rare complication following sleeve gastrectomy which is associated with significant mortality and morbidity. Patient’s follow-up and a clinical suspicion help clinicians to make appropriate decisions for management of these patients.

Keywords

• sleeve gastrectomty
• ovesco clip
• leak