Splenic Abscess after Sleeve Gastrectomy: A Report of Two Cases

Abstract Laparoscopic sleeve gastrectomy is currently a stand-alone bariatric procedure with a low complication profile. A rare complication of leak following sleeve gastrectomy was reported in this study. Its rareness and nonspecific clinical presentation could make the diagnosis difficult and could be easily confused with leak and subdiaphragmatic abscess. A 22-year-old Saudi female with body mass index 41 underwent laparoscopic sleeve gastrectomy in 2017, presented 18 months later to emergency department complaining of fever and abdominal pain for 3 months prior to presentation. Computed tomography of abdomen revealed a large splenic abscess, upper gastrointestinal studies were unremarkable. Patient was taken for laparoscopic exploration with finding of splenic abscess and gastric fistula, splenectomy and clipping of fistula was performed. The management of splenic abscess remains controversial. Splenectomy and antibiotics have generally been the definitive treatment particularly with large multilobulated collection. Familiarity with the rare complications as splenic abscess will allow for a prompt diagnosis and treatment.

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Splenic Abscess Complicating Bariatric Surgery : A Systematic Review

The American Surgeon ◽

10.1177/0003134821991971 ◽

2021 ◽

pp. 000313482199197

Author(s):

Md Mahfooz Buksh ◽

Simon Tallowin ◽

Ahmad Al Samaraee

Keyword(s):

Systematic Review ◽

Bariatric Surgery ◽

Sleeve Gastrectomy ◽

Laparoscopic Sleeve Gastrectomy ◽

Splenic Abscess ◽

Initial Operation ◽

Management Options ◽

Female Ratio ◽

Objective Evidence ◽

The Mean

Introduction Bariatric surgery has become one of the most rapidly growing subspecialty performed globally, and it has been well reported to be associated with low morbidity and mortality rates. Splenic abscess is a rare but serious complication of bariatric surgery that has not been previously systematically reviewed in the literature. Methods The authors have performed a systematic review of the evidence that has looked into the pathophysiology, clinical presentation, and the management options of splenic abscess complicating bariatric surgery. Results This systematic review has been unsurprisingly based on level-IV evidence due to the rarity of the explored condition. The final analysis included 27 relevant reported cases. The mean age was 38 years and the mean of the time interval between the initial operation and developing splenic abscess was 72 days, with the male to female ratio being 1:1.6. Laparoscopic sleeve gastrectomy was the initial operation in 85.2% of the patients. Nearly half of the patients did not have an objective evidence of local or systemic sepsis that could explain the abscess formation. Nonsurgical management was attempted in 14 patients, with 34% success rate only. Splenectomy was needed in 41.7% of the patients. No mortality was reported. Conclusions Splenic abscess is a rare and rather late but serious complication of bariatric surgery that could result in splenectomy in a relatively young group of patients. It is more commonly reported following laparoscopic sleeve gastrectomy. Early diagnosis with intervention in a timely manner is crucial to avoid life threatening complications.

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Delayed Intra Splenic Abscess: a Specific Complication Following Laparoscopic Sleeve Gastrectomy

Obesity Surgery ◽

10.1007/s11695-017-3069-8 ◽

2017 ◽

Vol 28 (2) ◽

pp. 589-593 ◽

Cited By ~ 2

Author(s):

Fajer Nassour ◽

Naim Michel Schoucair ◽

Hadrien Tranchart ◽

Sophie Maitre ◽

Ibrahim Dagher

Keyword(s):

Sleeve Gastrectomy ◽

Laparoscopic Sleeve Gastrectomy ◽

Splenic Abscess ◽

Specific Complication

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Management of sleeve gastrectomy leakage: case report

International Surgery Journal ◽

10.18203/2349-2902.isj20214386 ◽

2021 ◽

Vol 8 (11) ◽

pp. 3433

Author(s):

Ana C. Almeida ◽

Andreia Guimarães ◽

Maria J. Amaral ◽

Rita Andrade ◽

António Bernardes

Keyword(s):

Sleeve Gastrectomy ◽

Enteral Nutrition ◽

Surgical Procedures ◽

Splenic Abscess ◽

Oral Feeding ◽

Water Soluble ◽

Gastric Fistula ◽

Subphrenic Abscess ◽

Esophageal Transit ◽

Purulent Peritonitis

Treatment of postoperative gastric fistula complicated by local and systemic infection is difficult and controversial, particularly when treating obese patients with multiple prior surgical procedures. A 41-year-old male patient was transferred to our hospital to be admitted in the Intensive Care Unit with respiratory failure and postoperative sepsis, after being submitted to bariatric surgery. He had been through four subsequent surgical procedures: 1- a laparoscopic sleeve gastrectomy; 2- an exploratory laparotomy for unproven suspected subphrenic abscess; 3- a laparotomy with splenectomy and peritoneal drainage for splenic and peri-splenic abscess; 4-celiotomy and lavage for purulent peritonitis. Due to persistent clinical and analytical deterioration, and suspicion of left subphrenic abscess and digestive fistula, we proceeded to: identification and drainage of the abscess, adhesiolysis, identification of fistula orifice at the cardiac incisure (methylene blue and perioperative endoscopy), placement of a Pezzer tube for directed and controlled fistulization, Shirley’s drain in the subphrenic space for continuous lavage, jejunostomy for enteral nutrition. Under clinical and imaging control (esophageal transit, fistulography and computed tomography with water-soluble contrasts) he was started on a water diet 2 months after and the Shirley’s drain was later removed. Patient was discharged two and a half months after the intervention, maintaing the Pezzer tube and under enteral nutrition by jejunostomy. Oral feeding started in the 3rd postoperative month and jejunostomy and Pezzer probes were removed. Patient was asymptomatic at seven-month postoperative outpatient appointment.

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Delayed splenic abscess after laparoscopic sleeve gastrectomy

BMJ Case Reports ◽

10.1136/bcr-2014-208057 ◽

2015 ◽

Vol 2015 (feb17 1) ◽

pp. bcr2014208057-bcr2014208057 ◽

Cited By ~ 4

Author(s):

Y. Singh ◽

S. Cawich ◽

I. Aziz ◽

V. Naraynsingh

Keyword(s):

Sleeve Gastrectomy ◽

Laparoscopic Sleeve Gastrectomy ◽

Splenic Abscess

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Splenic abscess with portal venous gas caused by intrasplenic migration of an endoscopic double pigtail drain as a treatment of post–sleeve gastrectomy fistula

Surgery for Obesity and Related Diseases ◽

10.1016/j.soard.2015.07.017 ◽

2016 ◽

Vol 12 (1) ◽

pp. e1-e3 ◽

Cited By ~ 9

Author(s):

L. Genser ◽

F. Pattou ◽

R. Caiazzo

Keyword(s):

Sleeve Gastrectomy ◽

Splenic Abscess ◽

Portal Venous Gas

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Splenic Abscess after Sleeve Gastrectomy

Case Reports in Medicine ◽

10.1155/2020/4850675 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Rany Aoun ◽

Michel Gabriel ◽

Elias El Haddad ◽

Roger Noun ◽

Ghassan Chakhtoura

Keyword(s):

Abdominal Pain ◽

Sleeve Gastrectomy ◽

Ct Scan ◽

Laparoscopic Sleeve Gastrectomy ◽

Percutaneous Drainage ◽

Clinical Presentation ◽

Rare Complication ◽

Splenic Abscess ◽

Intravenous Antibiotics

Splenic abscess is a very rare complication of laparoscopic sleeve gastrectomy (LSG). Clinical presentation includes fever, leucocystosis, and abdominal pain. CT SCAN is a must for diagnosis. The preferred treatment is either conservative, with intravenous antibiotics and percutaneous drainage, or splenectomy. We report the thirteen case of a splenic abscess after LSG. In our patient, the abscess occurred three weeks after LSG in a 21-year-old man, and it was successfully treated conservatively.

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Management of leak after sleeve gastrectomy: outcomes of 73 cases, treatment algorithm and predictors of resolution.

Obesity Surgery ◽

10.1007/s11695-019-04203-w ◽

2019 ◽

Vol 30 (2) ◽

pp. 515-520 ◽

Cited By ~ 7

Author(s):

Moataz Bashah ◽

Nesreen Khidir ◽

Moamena EL-Matbouly

Keyword(s):

Sleeve Gastrectomy ◽

Treatment Algorithm ◽

Splenic Abscess ◽

Gastric Leak ◽

Resolution Time ◽

Feeding Jejunostomy ◽

Surgical Interventions ◽

Management Algorithm ◽

Tertiary Center ◽

Unit Conversion

Abstract Introduction Gastric leak post laparoscopic sleeve gastrectomy (LSG) is a severe complication that has been reported in 1.5–3% of cases. Management algorithms of leak exist; however, no known factors predict the time to resolution. This study aims to share outcomes of our management algorithm of post LSG leak, including the rate of resolution, complications, admission to the intensive care unit, conversion to other techniques, and mortality. To determine if any factors can predict the resolution time. Methods A retrospective analysis of patients who had LSG leaks and was managed in the main tertiary center in Qatar (January 2012–December 2017). Results A total of seventy-three patients had post LSG leaks. Fifty-six (76.7%) underwent LSG outside our center. Thirteen leaks (17.8%) were after revisional LSG. Laparoscopic exploration was performed in twenty patients (27.4%) and feeding jejunostomy in nine patients (12.3%). Patients were followed up for 12 months. All healed within 8.8 ± 0.72 weeks. The resolution rate was (97.1%) without surgical conversion, while two patients required fistulo-jejunostomy. No patient died. Complications occurred; re-leak (14.9%) and splenic abscess (2.9%). Patients on jejunal feeding had shorter resolution time (HR = 2.7, P = 0.018), while patients on total parenteral nutrition and post-endoscopic dilatation had 66% and 50% increases in the resolution time; (HR = 0.34, P = 0.026) and (HR = 0.5, P = 0.047), respectively. Conclusion Management of post-LSG leak is multimodal. Our clinical experience demonstrated less urge to perform extensive surgical interventions. Patients on enteral feeding had shorter resolution time while patients with sleeve stricture had a longer time to resolution.

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