Jad M Abdelsattar, MD, David Kelly, MD, Lawrence Tabone, MD, Nova Szoka, MD, Salim Abunnaja, MD. West Virginia University
Gastrogastric fistula (GGF) is a rare complication following laparoscopic Roux-en-Y gastric bypass (LRYGB). Patients can be asymptomatic, or present with abdominal pain, marginal ulceration (MU) or weight regain. To our knowledge, this is the first case in the surgical literature to describe an acute GGF bleeding requiring emergency surgery.
A 46 year-old female who underwent LRYGB 14 years ago presented with recurrent hematemesis and melena. She was found to have an actively bleeding GGF without evidence of MU. She failed multiple endoscopic interventions to control her bleeding. She was taken to the operating room emergently and underwent a remnant gastrectomy with excision of the GGF and fundectomy with pouchplasty. An upper endoscopy confirmed patency of the GJ anastomosis, negative air leak test and no evidence of gastrogastric fistula. The patient has since recovered well without further hematemesis and has lost 10 pounds 6 weeks postoperatively.
Despite complete partition of the stomach, GGF remains a potential complication following LRYGB. Gastrointestinal bleeding from the GGF, in the absence of MU is exceedingly rare and emphasizes the necessity of tailoring surgical therapy based on the presenting symptom as well as the location of the GGF relative to the gastrojejunal (GJ) anastomosis.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95115
Program Number: V044
Presentation Session: Bariatric I – Complications
Presentation Type: Video