Gastric Leak by Staple-Line Rupture after Sleeve Gastrectomy for Morbid Obesity

A 42-year-old, BMI 42kg/m2 female, suffering from arterious hypertension underwent laparoscopic sleeve gastrectomy. Intraoperative indocyanine-green enhanced fluorescence imaging showed proper vascularization of the gastric tube (Figure 1). A barium swallow on second postoperative day showed no leak or stenosis (Figure 2). A gastric fistula at the EGJ appeared 5 days after surgery. The patient presented fever, abdominal pain, dispnea, leukocytosis and high values of CRP. A thoraco-abdominal computed tomography (CT) scan with oral contrast detected a gastric leak just below the EGJ supplying a left sub diaphragmatic collection extended all over the spleen