AB165. SOH25_AB_012. Gastro-gastric fistula following one anastomosis gastric bypass: a case report and review of the literature

Background: One-anastomosis gastric bypass (OAGB) is a widely used procedure for treating obesity due to its effectiveness and safety. Gastro-gastric fistula formation between the gastric pouch and the gastric remnant is a rare complication post-bypass, typically presenting as weight regain. To date, it has been reported only following Roux-en-Y gastric bypass (RYGB). Herein, the authors present, to their knowledge, the first reported case of gastro-gastric fistula formation following OAGB.

Methods: Obtained informed consent for case report write-up including access to medical records and diagnostics.

Results: A 50-year-old woman with a significant smoking history presented to the emergency department with an acute exacerbation of chronic epigastric pain associated with nausea and vomiting. Her history was significant for an OAGB carried out 2.5 years previously which resulted in 76 kg weight loss. A pre-admission gastroscopy investigating postoperative epigastric pain had demonstrated severe peri-anastomotic ulceration. A computed tomography (CT) of abdomen and pelvis carried out following admission demonstrated contrast in the gastric remnant, raising suspicion for a gastro-gastric fistula. A repeat gastroscopy and a barium swallow confirmed the diagnosis. Acute management consisted of sucralfate and high-dose proton pump inhibitor for ulcer management and nasojejunal feeding. She was discharged with a plan for repeat gastroscopy and eventual laparoscopic resection of the fistulous tract.

Conclusions: To the authors’ knowledge, this represents the first case of a gastro-gastric fistula formation following OAGB. We report an atypical presentation, without weight regain most typically associated with this complication, and suggest severe peptic ulceration as the likely aetiology.

Keywords: Bariatric; complications; emergency; fistula; surgery