AB136. SOH21AS046. Delayed gastropleural fistula: a rare cause of a persistent pleural effusion after blunt force trauma
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AB136. SOH21AS046. Delayed gastropleural fistula: a rare cause of a persistent pleural effusion after blunt force trauma

Kin Yik Chan1, Shane Keogh1, Nitin Aucharaz1, Hugo Temperley2, James O’Driscoll3, Narayanasamy Ravi2, Shona Tormey1

1Department of Breast Surgery, University Hospital Limerick, Limerick, Ireland; 2Department of General Surgery, St James’s Hospital, Dublin, Ireland; 3Department of Anaesthetics and Critical Care, University Hospital Limerick, Limerick, Ireland

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.

Methods: 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.

Keywords: Gastropleural; fistula; aero-digestive; diaphragmatic rupture; trauma; pleural effusion; empyema


Funding: None.


Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-21-ab136
Cite this abstract as: Chan KY, Keogh S, Aucharaz N, Temperley H, O’Driscoll J, Ravi N, Tormey S. SOH21AS046. Delayed gastropleural fistula: a rare cause of a persistent pleural effusion after blunt force trauma. Mesentery Peritoneum 2021;5:AB136.

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