The incidence of morbid obesity in the United States is increasing. Roux-en-Y Gastric Bypass is a surgical treatment for morbid obesity resulting in weight loss and control or resolution of obesity-related co-morbidities, however, is not without complications. More common post-surgical complications include anastamotic leaks or strictures, bowel obstruction or vitamin/mineral deficiency. While relatively rare, marginal ulceration, gastro-gastric and gastro-cutaneous fistulae have been reported. This is a case report of a patient that developed a gastro-colonic fistula.
This patient is a 34 year old female with a remote history of an open Roux-en-Y Gastric bypass with subsequent marginal ulcer and gastric pouch disruption requiring two revisions, and an incisional hernia requiring repair. She presented with weight loss, p.o. intolerance, diarrhea and abdominal pain for several months. Preoperative workup with contrast swallow, esophago-gastro-duodenoscopy (EGD), colonoscopy and computed tomography (CT) revealed a gastro-colonic fistula. The fistula and malnutrition were managed preoperatively withholding oral intake and starting total parenteral nutrition (TPN). During exploratory laparotomy, a fistula was identified between the gastrojejunal anastamotic site and proximal transverse colon. Treatment included excision of the fistula with repair of the gastrojejunostomy and an extended right hemicolectomy. A postoperative swallow study revealed no leak at the repair site. During the postoperative course an intra-abdominal fluid collection was identified and drained percutaneously. The patient also had a prolonged ileus. Currently the patient is improving with complete resolution of presenting symptoms, weight gain and p.o. tolerance.
Fistula development as a complication after Gastric Bypass can be catastrophic. Gastro-colonic fistula is a rare complication and to our knowledge this is the first case report of a Gastro-Colonic fistula after this type of procedure. This should be considered in the differential diagnosis when a patient presents with PO intolerance, diarrhea and malnutrition after gastric bypass surgery.
Program Number: P082