Presentation
Day 3 post sleeve gastrectomy, presenting with epigastric pain, fever and tachycardia.
Patient Data
Patient is status post recent sleeve gastrectomy with large well-defined perigastric collection measuring approx 5 x 10 x 15 cm (TR X CC X AP dimensions respectively) showing heterogeneous, mostly fluid density contents and multiple air locules with mild peripheral enhancement, and surrounding marked fat stranding. There is continuity of intra-gastric air column to perigastric air locules & fluid collection, also likely defect at the fundal region adjacent to the gastro-esophageal junction.
Subcutaneous fat stranding at anterior abdominal wall noted, no definite localized collection; likely postoperative changes.
Mild free pelvic fluid.
Pig tail drainage tube is noted at the left hypochondrial region.
Continued small contained leak of water soluble contrast at the perigastric region, adjacent to the gastro-esophageal junction. It measures approx 1.0 x 2.6 cm.
Case Discussion
The patient presented with fever, and tachycardia shortly after a sleeve gastrectomy, with clinical suspicion of staple line leakage.
CT confirmed large perigastric abscess formation secondary to staple line leakage mostly at the gastro-esophageal junction.
Percutaneous CT guided drainage was done immediately and a pigtail drainage tube was deployed at the site of the abscess with a purulent fluid output.
Water-soluble study confirmed the site of leak at the gastro-esophageal junction and revealed small residual contained perigastric collection.
Leak after sleeve gastrectomy often occurs at the first few days postoperative due to failure of staple line complete closure.
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