Case Report
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2025; 17(6): 107033
Published online Jun 27, 2025. doi: 10.4240/wjgs.v17.i6.107033
Chronic gastro-abdominal wall fistula with secondary massive thoracoabdominal wall abscess and costal destruction after laparoscopic gastricolithotomy: A case report
Yong-Zhen Kang, Jian-He Sun
Yong-Zhen Kang, Jian-He Sun, Department of Hepatobiliary Surgery, Tianjin Baodi Hospital, Tianjin Medical University Baodi Hospital, Tianjin 301800, China
Author contributions: Kang YZ proposed the study; Kang YZ and Sun JH collected and analyzed the clinical data, contributed to the design and interpretation of the study; and all authors have read and approved the final version to be published.
Informed consent statement: The patient and her family members provided written informed consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian-He Sun, FRCS, MD, Department of Hepatobiliary Surgery, Tianjin Baodi Hospital, Tianjin Medical University Baodi Hospital, No. 8 Guangchuan Road, Baodi District, Tianjin 301800, China. 18602249294@163.com
Received: March 14, 2025
Revised: April 8, 2025
Accepted: April 28, 2025
Published online: June 27, 2025
Processing time: 77 Days and 20.8 Hours
Abstract
BACKGROUND

Although laparoscopic gastrolithotomy had been widely used in clinical practice, uncommon postoperative complications still require vigilance by medical staff.

CASE SUMMARY

Here we report a 67-year-old man who suffered for 18 months and underwent surgery several times due to a rare and undetected complication of laparoscopic gastricolithotomy. He presented to multiple hospitals because of sustained left upper quadrant abdominal pain one month after laparoscopic gastricolithotomy due to a large gastric bezoar caused by unrestrained eating of black dates and was diagnosed with possible intercostal neuritis. Many painkillers were used to relieve his symptoms but the condition progressed. Seven months after surgery, he was hospitalized as skin ulceration occurred in the left upper abdominal wall and was subsequently diagnosed with a massive thoracoabdominal wall abscess. One year after surgery, irreversible costal destruction was demonstrated. Both lesions were finally proved to be secondary damage due to a rare chronic gastro-abdominal wall fistula related to laparoscopic gastricolithotomy and the diameter of the gastric fistula reached 2 centimeters (cm). The patient was ultimately cured but underwent multi-regional incisions and drainage of the abscess, drainage of the gastric fistula, partial gastrectomy and removal of damaged ribs, and was followed-up for more than 4 years without recurrence. It is well-known that gastric fistula usually has an acute onset and occurs early after surgery, while chronic gastro-abdominal wall fistula especially with secondary massive thoracoabdominal wall abscess and costal destruction has rarely been reported.

CONCLUSION

This may be the first reported case of a chronic thoracoabdominal abscess and costal destruction caused by an undetected chronic gastro-abdominal wall fistula. We believe that this is a novel type of gastric fistula and the diagnosis and treatment were challenging.

Keywords: Gastro-abdominal wall fistula; Thoracoabdominal wall abscess; Costal destruction; Laparoscopic gastricolithotomy; Gastrolithiasis; Case report

Core Tip: We report a 67-year-old man who underwent surgery several times for a rare and undetected complication of laparoscopic gastricolithotomy. He presented to multiple hospitals because of sustained left upper quadrant abdominal pain one month after laparoscopic gastricolithotomy and was subsequently diagnosed with a massive thoracoabdominal wall abscess seven months after surgery, and irreversible costal destruction one year after surgery. Both lesions were finally confirmed to be secondary damage due to a rare chronic gastro-abdominal wall fistula related to laparoscopic gastricolithotomy and the diameter of the gastric fistula reached 2 cm.