497 Delayed Gastropleural Fistula: A Rare Cause of a Persistent Pleural Effusion After Blunt Force Trauma

Background A gastropleural fistula (GPF) is a rare pathological connection between the stomach and pleural cavity. GPFs have been reported following traumatic diaphragmatic ruptures, perforated hiatal hernias and gastric fundal ulcers, and more recently, after bariatric surgery. Diagnosis and treatment are frequently delayed due to the lack of specific clinical, laboratory and radiological findings. Method We describe a case of a 53-year-old gentleman who presented to our institution with acute respiratory distress and clinical findings of a pleural effusion. Uniquely he was discharged a week prior following an admission for a traumatic fall down a flight of stairs that resulted in a Grade-IV splenic injury, requiring an emergency splenectomy. A CT-proven massive haemothorax resulted in haemodynamic instability requiring resuscitation and chest drain insertion in the intensive care unit. On commencement of enteral diet, purulent exudate with evidence of food particulates was seen in his chest drain. Results Further diagnostic evaluation of drainage contents demonstrated gut flora and a subsequent positive dye test suggested an aero-digestive connection. Repeat CT revealed a fistula between the fundus of the stomach and the left pleural cavity through a ruptured diaphragm. He underwent an open sleeve gastrectomy and primary repair of the diaphragm. Conclusions This is the first case in literature reporting a ‘gastropleural fistula’ presenting in such a fashion. Thorough assessment and decisive action led to a satisfactory outcome. Although rare, a persistent effusion with a history of blunt abdominal and thoracic trauma may herald a GPF, which, if not diagnosed promptly, may result in significant morbidity.

Delayed gastropleural fistula: a rare cause of a persistent pleural effusion after blunt force trauma

A gastropleural fistula (GPF) is a rare pathological connection between the stomach and pleural cavity. Diagnosis and treatment are frequently delayed due to the lack of specific clinical, laboratory and radiological findings. We describe a case of a 53-year-old gentleman who presented to our institution with respiratory sepsis and a massive haemopneumothorax on imaging. Uniquely, he was discharged a week prior after a splenectomy for a traumatic fall. Gut flora in the pleural fluid and a subsequent positive dye test suggested an aero-digestive connection. Repeat imaging revealed a fistula between stomach and the left pleural cavity through a ruptured diaphragm. He underwent an open sleeve gastrectomy and primary repair of the diaphragm. This is the first GPF in literature presenting in such a fashion. Although rare, a persistent effusion with a history of blunt thoracoabdominal trauma may herald a GPF, which, if not diagnosed promptly, may result in significant morbidity.

Late Gastropleural Fistula Following Bariatric Surgery: Case Report

Although bariatric surgery procedures represent well-established methods for sustained weight loss worldwide, an important number of postoperative complications can be expected in both restrictive and mixed procedures. Gastropleural fistulas (GPF) represent an extremely rare life-threatening complication following bariatric surgery. Defined as a pathological communication between the gastric tract and the pleural cavity, the establishment of an appropriate and timely diagnosis may be quite challenging for physicians. We report on a case of a 33-year-old woman, who underwent a bariatric sleeve procedure, who presented several episodes of pneumonia in different occasions postoperatively with undiagnosed causes. Three years postoperatively the patient was hospitalized for a more detailed investigation and underwent video segmentectomy unsuccessfully. GPF was diagnosed following the observation of nutritional supplement escaping through the chest drain. The patient was initially treated with different endoscopic techniques (argon glow plasma, and endoscopic balloon dilatation) for the closure of the GPF, but despite all attempts, she eventually progressed to total gastrectomy. Bariatric surgery patients suffering from recurrent episodes of pneumonia should raise the alert for the possibility of GPF.