POSTOPERATIVE PERITONITIS DUE TO FISTULA AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY

I. Slavu 1, V. Braga1, L. Alecu1
1The General Surgery Clinic, the Emergency Clinical Hospital “Prof. Dr. Agrippa Ionescu”, Bucharest, Romania
Corresponding author: Lucian Alecu
Phone no. 0040722513768
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Abstract

We present the case of patient SS aged 44 who had undergone bariatric surgery (BMI=44 kg/m2) – a laparoscopic sleeve gastrectomy. Five days after surgery he presented to the emergency room with clinical symptoms suggestive of peritonitis. Abdominal radiography identified pneumoperitoneum. Ultrasound examination showed the existence of peritoneal fluid in small quantity. Biological analysis of the blood showed leukocytosis and inflammatory syndrome. Laparoscopic emergency surgery was undertaken - when the optic trocar was introduced – minimum pneumoperitoneum was eliminated. The laparoscopic exploration of the peritoneal cavity showed cloudy peritoneal fluid in a minimum quantity and a small fistula which corresponded to a failded mechanical suture clip. Lavage and aspiration were practiced profusely (5L), multiple peritoneal drainage and installation of a nasogastric tube under laparoscopic control. The postoperative evolution was favorable with bowel movements being regained and progressive removal of the drainage tubes. The patient was discharged on postoperative day 7 after reoperation. Laparoscopic approach can be used successfully in reinterventions after bariatric surgery.

Keywords: sleeve gastrectomy, gastric fistula, obesity

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