# Recurrent Stent Migration in a Patient With a Gastropleural Fistula Following a Single Anastomosis Sleeve Ileal Bypass Procedure Resulted in Bowel Resection

## TL;DR

A patient with a rare complication after bariatric surgery faced repeated stent migration, leading to bowel resection.

## Contribution

This is the first reported case of gastropleural fistula following single anastomosis sleeve ileal bypass surgery.

## Key findings

- Endoscopic stenting failed due to recurrent stent migration in a patient with a gastropleural fistula.
- Persistent stent migration led to small bowel obstruction requiring surgical intervention.
- The case suggests abnormal gastrointestinal motility changes may occur after SASI surgery.

## Abstract

Gastropleural fistula (GPF) is a rare complication following bariatric surgery, most commonly reported after laparoscopic sleeve gastrectomy, with no previously documented cases following single anastomosis sleeve ileal bypass (SASI). Endoscopic stenting is considered the primary management strategy for post-bariatric gastric fistulas and generally demonstrates a high success rate. However, stent migration remains a significant complication that can result in considerable morbidity.

We report a case of a 32-year-old male who developed a chronic GPF following the SASI procedure. Initial management involved endoscopic stenting; however, the patient experienced recurrent stent migration, which ultimately resulted in small bowel obstruction. This complication necessitated an exploratory laparotomy and subsequent bowel resection. The persistent stent migration observed in this case may be linked to abnormal gastrointestinal motility changes following bariatric surgery.

This case highlights the need to consider early surgical intervention in select cases and emphasizes the importance of prospective studies investigating post-SASI motility changes.