A case report of an early gastrocolic fistula following Roux-en Y gastric bypass, a unique and uncommon complication

TL;DR

This paper reports a rare early gastrocolic fistula after gastric bypass surgery that was successfully treated with endoscopic stenting.

Contribution

The first reported case of an early gastrocolic fistula originating from the gastric pouch managed non-surgically.

Findings

Gastrocolic fistula presented unusually early after surgery and originated from the gastric pouch.

Endoscopic stenting successfully managed the fistula without the need for surgery.

Early diagnosis and a skilled team were critical for non-surgical management.

Abstract

Gastrocolic fistula (GCF) following Roux-en-Y gastric bypass (RYGB) is uncommon. Usually it presents late with nonspecific symptoms and originates from the gastrojejunostomy (GJ). Management of such complication can be surgical, but endoscopic management can be implemented in selected patients. To our knowledge this is the first case reporting an early GCF originating from gastric pouch successfully managed with endoscopic stenting.

A 54-year-old female, with surgical history of open vertical band gastroplasty (VBG), complaining of weight regain and reflux symptoms. The plan was to laparoscopically convert VBG to RYGB. Two weeks after, she presented unusually with only fatigue and epigastric pain.

Leak was suspected and needed to be ruled out. The patient was presenting in an unusual presentation, i.e. vitally stable and only fatigued. Workup including laboratories, computed tomography, and endoscopy confirmed staple line disruption with development of early GCF. Management included endoscopic fully covered stent, total preantral nutrition.

With a well-trained team and the availability of expertise, GCF can be managed with endoscopic stents.

•Gastrocolic fistula after Roux-en-Y gastric bypass in the context of bariatric surgery is fairly rare.•Fistula forming at gastrojejunostomy are the most common, presenting as a late complication, with nonspecific symptoms.•Our case is unique in its location, time interval, and how it was successfully managed non surgically.

Gastrocolic fistula after Roux-en-Y gastric bypass in the context of bariatric surgery is fairly rare.

Fistula forming at gastrojejunostomy are the most common, presenting as a late complication, with nonspecific symptoms.

Our case is unique in its location, time interval, and how it was successfully managed non surgically.

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