Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Nov 27, 2015; 7(11): 345-348
Published online Nov 27, 2015. doi: 10.4240/wjgs.v7.i11.345
Gastric remnant twist in the immediate post-operative period following laparoscopic sleeve gastrectomy
Gokulakkrishna Subhas, Anupam Gupta, Mubashir Sabir, Vijay K Mittal
Gokulakkrishna Subhas, Anupam Gupta, Mubashir Sabir, Vijay K Mittal, Department of Surgery, Providence Hospital and Medical Centers, Southfield, MI 48075, United States
Author contributions: All authors contributed to the acquisition of data, writing, and revision of manuscript; the manuscript has been seen and approved by all authors and the material is previously unpublished.
Institutional review board statement: This case report was exempt from the Institutional Review Board Standards at Providence Hospital and Medical Centers, Southfield, MI 48075, United States.
Informed consent statement: The patient involved in this study has given her written informed consent authorizing use and disclosure of her protected health information.
Conflict-of-interest statement: All the authors have no conflict of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Gokulakkrishna Subhas, MD, Resident in General Surgery, Department of Surgery, Providence Hospital and Medical Centers, 16001 W. Nine Mile Road, Southfield, MI 48075, United States. drsgokul@yahoo.com
Telephone: +1-248-8498902 Fax: +1-248-8495380
Received: June 12, 2015
Peer-review started: June 14, 2015
First decision: August 4, 2015
Revised: September 16, 2015
Accepted: October 12, 2015
Article in press: October 13, 2015
Published online: November 27, 2015
Processing time: 168 Days and 10.5 Hours
Abstract

Twist of stomach remnant post sleeve gastrectomy is a rare entity and difficult to diagnose pre-operatively. We are reporting a case of gastric volvulus post laparoscopic sleeve gastrectomy, which was managed conservatively. A 38-year-old lady with a body mass index of 54 underwent laparoscopic sleeve gastrectomy. Sleeve gastrectomy was performed over a 32 French bougie using Endo-GIA tri-stapler. On post-operative day 1, patient had nausea and non-bilious vomiting. An upper gastrointestinal gastrografin study on post-operative days 1 and 2 revealed collection of contrast in the fundic area of stomach with poor flow distally, and she vomited gastrograffin immediately post procedure. With the suspicion of a stricture in the mid stomach as the cause, the patient was taken back for a exploratory laparoscopy and intra-operative endoscopy. We found a twist in the gastric tube which was too tight for the endoscope to pass through. This was managed conservatively with a long stent to keep the gastric tube straight and patent. The stent was discontinued in 7 d and the patient did well. In laparoscopic sleeve gastrectomy the stomach is converted into a tube and is devoid of its supports. If the staples fired are not aligned appropriately, it can predispose this stomach tube to undergo torsion along its long axis. Such a twist can be avoided by properly aligning the staples and by placing tacking sutures to the omentum and new stomach tube. This twist is a functional obstruction rather than a stricture; thus, it can be managed by endoscopy and stent placement.

Keywords: Gastric remnant; Stent; Sleeve gastrectomy; Volvulus; Obesity

Core tip: Twist of the stomach remnant post sleeve gastrectomy is a rare entity. We are reporting a case of gastric twist post laparoscopic sleeve gastrectomy. This was managed conservatively with a long stent for 7 d. In laparoscopic sleeve gastrectomy the stomach is converted into a tube and is devoid of its supports, making it prone for twisting. Such a twist can be avoided by properly aligning the staples and by placing tacking sutures to the omentum. This twist is a functional obstruction rather than a stricture; thus, it can be managed by endoscopy and stent placement.