Fístula gastrobrônquica como complicação rara de gastroplastia para obesidade: relato de dois casos / Gastrobronchial fistula as a rare complication of gastroplasty for obesity: a report of two cases

A fístula gastrobrônquica é uma condição rara como complicação decorrente de cirurgia da obesidade. O seu manejo exige a participação ativa de um pneumologista, o qual deve conhecer alguns aspectos dos principais tipos de cirurgia bariátrica. Neste relato, descrevemos dois casos de pacientes que apresentaram abscessos subfrênico e pulmonar recidivantes secundários a fístula no ângulo de His durante 19,5 meses, em média. Após o insucesso das relaparotomias, a cura foi obtida por meio da antibioticoterapia e, principalmente, por meio da estenostomia e da dilatação endoscópica, além do uso de clipes e cola de fibrina na fístula. Estas complicações pulmonares não devem ser tratadas isoladamente sem uma avaliação gastrintestinal pois isso pode resultar em piora do quadro respiratório, dificultando o manejo anestesiológico durante procedimentos endoscópicos.

Gastrobronchial fistula is a rare condition as a complication following bariatric surgery. The management of this condition requires the active participation of a pulmonologist, who should be familiar with aspects of the main types of bariatric surgery. Herein, we report the cases of two patients who presented recurrent subphrenic and lung abscess secondary to fistula at the angle of His for an average of 19.5 months. After relaparotomy was unsuccessful, cure was achieved by antibiotic therapy and, more importantly, by stenostomy and endoscopic dilatation, together with the use of clips and fibrin glue in the fistula. These pulmonary complications should not be treated in isolation without a gastrointestinal evaluation since this can result in worsening of the respiratory condition, thus making anesthetic management difficult during endoscopic procedures.

A Case of Subphrenic Abscess with Ileal Fistula Caused by Metastatic Adenocarcinoma of Unknown Origin / 대한소화기학회지

Usual sources of subphrenic abscess with intestinal fistula are previous abdominal operation, inflammatory bowel disease and malignancy. Reported cases of intestinal fistula caused by adenocarcinoma were complicated by direct invasion. In this report, a 70-year-old male had a subphrenic abscess with intestinal fistula and the cause was a metastatic adenocarcinoma of unknown origin. As far as we know, this has not been reported previously in the literatures. The abscess went on chronic course for six months because intermittent administration of antibiotics modified its clinical presentation. The fistulous tract between the abscess and ileum was demonstrated by tubogram via the drainage catheter in abscess. The patient underwent surgical treatment because the cause of fistula was obscure. Invasion of the ileum by metastatic adenocarcinoma was diagnosed by the histologic examination of surgical specimen. Therefore, when a fistula develops without any apparent cause, there is a possibility of malignancy, and surgical approach must be considered. An early surgical approach will prevent the delay in treatment and reduce the mortality.

Subphrenic Abscess Due to Retained Gauze / 대한흉부외과학회지

Eighty-four-year old man who had lapalotomy for stomach ulcer perforation 35 years ago was admitted for left lower chest discomfort. Chest X-ray and CT showed a large mass with air fluid level in left lower lung field. The tentative diagnosis was infected bronchogenic cyst. After a thoracotomy, the mass was confirmed as elevated diaphragm and subphrenic abscess with a foreign body, retained surgical gauze. The pus and gauze were located between stomach and diaphragm. His hospital course was smooth and uneventful, he was discharged with good outcome on postoperative day 9.

A Case of Pleural Effusion Caused by Ventriculoperitoneal Shunt and Subphrenic Abscess / 소아알레르기및호흡기학회지

Several different diseases may have an associated exudative pleural effusion. In a patient with a pleural effusion of unknown origin, a possibility of intra-abdominal abscess should always be considered, especially in a patient who has the past history of abdominal surgery or procedure. We describe a 5-year-old male patient who had been operated for congenital hydrocephalus with ventriculo-peritoneal shunt insertion at 15 months old, admitted to our hospital with complaints of headache and edema of valvular area. Brain CT scan revealed shunt disconnection, and he was operated for insertion of new shunt catheter. Seven days after first operation, he presented fever, abdominal pain and distension. Abdominal ultrasonography revealed bowel adhesion and peritonitis. Staphylococcus epidermidis was isolated by aspiration of shunt valve and reservior, repeatedly. He should have had another 2 operations of peritoneal lavage and catheter change for shunt infection associated peritonitis. Eight days after the 3rd operation, he complained newly developed left shoulder, left chest pain and fever up to 39 degrees C. His chest x-ray revealed pleural effusion on the left side. Though antibiotic therapy was already being conducted, the left pleural effusion and fever aggravated. Repeated ultrasonography disclosed an occult left subphrenic abscess, explaining the fever and left pleural effusion on the radiograph. Fourth operation of abscess drainage and infected shunt removal with extraventricular drainage was done. After the operation, his fever and pleural effision were rapidly disappered, and postoperative CSF culture was negative. A review of ventriculoperitoneal shunt infection associated with subphrenic abscess and pleural effusion was discussed.

A Case of Subphrenic Abscess after Hassab's Operation Successfuly Treated with Shinbu-to / 日本東洋医学雑誌

A case of subphrenic abscess after Hassab's operation successfully treated with the Kampo formula Shimbu-to is reported. A 43-year-old woman who had been suffering from cirrhosis of the liver and pancytopenia received an operation. Ten days following the operation, she developed a fever. The condition was diagnosed as postsplenectomic sepsis and steroid hormones were given. On day 35 following surgery, a subphrenic abscess was detected by CT scan and echography. The abscess was drained using echography, and several types of antibiotics given, however, these therapies were not effective. After administration of the Kampo formula Shimbu-to, the subphrenic abscess decreased.<br>Shimbu-to proved effective in the treatment of a subphrenic abscess that did not respond to Western medical drainage and antibiotic treatment methods.