Gastropleural Fistula Secondary to Benign Ulcer Disease: Minimally Invasive Management
Caitlin Takahashi-Pipkin1, Brett Starr2, Carlos Anciano2, Mark Iannettoni2, Andrea Oliver2, James Speicher2.
1East Carolina University, Winterville, NC, USA, 2East Carolina Heart Institute, Greenville, NC, USA.
TITLE: Gastropleural fistula secondary to benign ulcer disease: Minimally Invasive Management
ABSTRACTBackgroundThe formation of a gastropleural fistula is a rare occurrence and can be a complication of trauma, malignancy, surgery, and hiatal or diaphragmatic hernias. The operative management of a gastropleural fistula due to a benign solitary gastric ulcer has not previously been described and there is no current standard of care.CaseA 65-year-old Caucasian male with past medical history of rheumatoid arthritis on chronic steroids and NSAIDS and no surgical history presented in sepsis and was found to have a large left pleural effusion and pneumoperitoneum communicating through the left hemidiaphragm to the left thorax. Upon surgical exploration the patient was found to have a gastro-pleural fistula due to a solitary ulcer in the fundus of the stomach that perforated and eroded through the diaphragm into the left lower lobe and thoracic cavity. He was managed with tube thoracostomy, laparoscopic takedown of gastropleural fistula and sleeve gastrectomy, and delayed laparoscopic diaphragmatic hernia repair with biologic extracellular matrix patch. His hospital stay was extended by sepsis secondary to left lower lobe necrosis secondary to corrosive gastric secretions. He recovered and eventually was discharged to a rehab facility. Pathology demonstrated benign disease.
ConclusionGastropleural fistula due to benign gastric ulcer disease is an extremely rare entity with few reported surgical techniques for management of these complications. We report the first gastropleural fistula secondary to benign ulcer disease and demonstrate minimally-invasive feasibility in the operative management of this presentation.
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