Conservative Management of Gastric Twist and Leak Post Band Removal and Sleeve Gastrectomy.

AIM: Gastric twist is a rare, however, troublesome complication of laparoscopic sleeve gastrectomy. This report describes a case complicated by perforation and leak in addition to twist. The patient was managed conservatively and successfully.

CASE PRESENTATION: A 29-year-old female patient with a body mass index (BMI) of 41.3 kg/m2 (111 kg/1.64 m), who underwent gastric band insertion six years ago, recently experienced postprandial vomiting. Endoscopic examination revealed grade A esophagitis, minor antral gastropathy, and mild bulbar duodenitis. Her BMI was calculated at 33.1 kg/m2 (89 kg/1.64 m). One week later, she had a laparoscopic band removal and sleeve gastrectomy using an endo GIA Tri-stapler. Both the surgical and postoperative periods proceeded without complications, and she was discharged home the next day after surgery. The patient was readmitted after two weeks due to an organo-axial gastric volvulus, which was managed with stent placement. Six weeks following, a stomach leak and peri splenic fluid collection were diagnosed. A 12 mm Ovesco clip was employed to seal a perforation situated 35 cm from the incisors. Subsequently, a MEGA bariatric stent was placed.

RESULTS

Two months after the removal of the MEGA stent, the patient had recovered completely and was in good health.

CONCLUSIONS

Gastric twist after sleeve gastrectomy is a rare condition; a high index of suspicion is required for diagnosis. Prioritize conservative treatment to prevent the risk of revisional surgery.