Postoperative gastric fistula

Abstract

Aim-Background

The aim of this study is to highlight the modern diagnostic tools and treatment options for this surgical complication which, if not addressed, could prove life-threatening. Gastrocutaneous fistula (GF) is a rare and serious surgical complication. It usually arises from a traumatized or ischemic stomach wall or gastrojejunal anastomosis following major operations of the upper abdomen or after a leak from a gastroduodenal or gastrojejunal anastomosis. A long standing gastrostomy tube constitutes another common etiologic factor. The increased incidence of GFe in recent years can also be attributed to bariatric surgical procedures.

Patients-Methods

We report three cases of GFe occurring after major operative procedures that were treated either endoscopically or surgically. A short review of the literature related to GFe is also presented.

Discussion-Conclusion

The incidence of isolated gastric fistula ranges between 2–20% among different series. The greater curvature of the gastric fundus is the most common site involved. Although the etiology is not well understood, it is postulated that a traumatized, ischemic gastric wall in contact with a foreign body material and surrounded by a significant inflammatory process is a situation conducive to development of a GF. Diagnostic evaluation includes upper GI contrast radiography which is the most accurate technique to demonstrate the tract of the fistula. Treatment of this frustrating complication is initially conservative with the use of supportive measures; surgical intervention should be decided when all other treatment options fail. Endoscopic closure of the leakage defect using metal clips, fibrin glue or other agents provides another current and promising option in the management of GFe.