1Abdulmajeed Bin Dahmash, 1Shaima Ahmed Abdulrahman, 1Aljabriyah Alfutais, 1Omar Bashir, 1Mohammad Arabi, 1Mohammed Almoaiqel

1Vascular and Interventional Radiology Unit, Department of Medical Imaging, King Abdulaziz Medical City & King Abdullah Specialized Children’s Hospital, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia

 

Case Report:

Staple line leak is reported in 1-5% post sleeve gastrectomy. Leak can be treated by surgical revision, stent placement or endoscopic interventions. Leak may progress to chronic fistula and may result in gastropleural or gastrobronchial fistulas. We report two cases of gastrobronchial fistula, one was successfully treated with glue embolization, and the other underwent surgical repair after unsuccessful glue embolization. The first case is a 25-year-old female who developed chronic gastrobronchial fistula following stable line leak post sleeve gastrectomy. Initial management with a covered gastroesophageal stent failed to treat the fistula. Endoscopic clipping also failed to seal the fistula.  Therefore, glue embolization of the fistula was performed via oral approach. Contrast injection confirmed presence of fistula between the stomach and left lower lobe bronchus. Glubran II (GEM Srl, Viareggio, Italy) was successfully injected to embolize the tract. Follow up CT scan at three months showed complete resolution of the fistula and marked improvement in the left lower lobe inflammatory changes. The second case is a 28-years-old female also developed gastrobronchial leak and fistula post sleeve gastrectomy. A trial of gastroesophgeal stenting for 7 weeks failed to resolve the fistula. Fistula tract was selected with a microcatheter and embolization with Glubran II (1:1 Glubran II:Lipiodol) was performed. Follow up CT scan one month later showed persistent gastrobronchial fistula associated with left lower lobe consolidation and pleural effusion. Patient underwent laparotomy with fistulectomy and Roux-en-Y gastrojejunostomy. Glue embolization may be considered as a minimally invasive option for the management of gastrobronchial fistula post sleeve gastrectomy. However, surgical operation may be required as a definitive intervention when less invasive procedures fail.