• Skip to primary navigation
  • Skip to main content
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • SAGES Store
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
    • “Unofficial” Logo Products
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2024 Scientific Session Call For Abstracts
      • 2024 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Fellows Career Development Course
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • OWLS
  • Log In

Hematoma after Sleeve Gastrectomy Causing Gastric Outlet Obstruction and Severe Malnourishment.

Rami R Mustafa, MD, Leena Khaitan, MDMPH, Ananda Ghimire, PA, Benjamin Jons, PA, Tomasz Rogula, MDPhD. Cleveland Medical Center

Introduction: Sleeve Gastrectomy is one of the most common bariatric procedures. Risks include stapler line bleeding. Chronic anticoagulation for VTE prophylaxis may increase risk of bleeding. Meticulous surgical hemostasis is needed to prevent from such complications. Stapler line oversawing or buttressing is used for local hemostasis. Postoperative hematoma may create extrinsic compression of the stomach and partial or complete gastric outlet obstruction with nutritional sequela. Optimal management is debatable. Early evacuation of hematoma may increase risk of re-bleeding. CT guided drainage may not be effective for thick content of hematoma.

Case Presentation: We present a case of 65 year old female who underwent laparoscopic sleeve gastrectomy 4 weeks prior to readmission.  Surgery was complicated by postoperative hematoma from staple line bleeding.  The patient was on chronic anticoagulation for VTE prophylaxis. Unsuccessful surgical and radiological drainage was attempted 2 weeks after sleeve gastrectomy. The patient presented with abdominal pain, nausea and vomiting, significantly malnourished with decreased albumin and pre-albumin, excessive weight loss about 85 pounds with BMI decreased from 65 to 48 within 4 weeks. Comorbidities include history of PE, IVC filter, type 2 diabetes, chronic venous stasis, immobility. CT abdomen/pelvis revealed irregular fluid collection on latero-posterior wall of sleeve gastrectomy with features suggesting abscess. Extrinsic compression was seen on preoperative UGI and gastroscopy.

Methods/Surgical procedure: A standard, 5-trockars  laparoscopy was done for very extensive adhesiolysis. A large encapsulated hematoma was found near the gastric body and pre-antrum, adhering firmly to the gastric wall and surrounding structures. Intraoperative gastroscopy was used to identify anatomy. Pseudo-capsule of the hematoma was excised to prevent from reoccurrence. Thick matured hematoma with purulent content was evacuated with suction and the Endobag.  A 10F JP drain was placed into the hematoma cavity.

Post-Procedure Course and 30-day outcomes: Abdominal pain, nausea, vomiting resolved, and nutritional status significantly improved. Follow up CT scan showed complete resolution of hematoma.

Conclusions: Prevention includes meticulous surgical hemostasis. Early evacuation of peri-gastric hematoma prevents from infection and extrinsic compression of the stomach. Excessive weight loss and malnourishment are consequences of gastric outlet obstruction due to hematoma. Surgical treatment includes evacuation of hematoma and excision of its pseudocapsule to prevent from reoccurrence. Intra-operative gastroscopy helps with anatomical orientation. Radiological drainage may not be effective in chronic infected hematomas.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 88018

Program Number: V250

Presentation Session: Friday Video Loop (Non CME)

Presentation Type: VideoLoop

2,124

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064
1-310-437-0544
[email protected]
Monday - Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2023 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons