Case Report: Gastro-bronchial fistula complicating a sleeve gastrectomy - from a glimmer of hope to a plight - version 1

Sep 28, 2026

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Bariatric surgery, particularly sleeve gastrectomy, offers effective long-term treatment for morbid obesity, yet it can lead to severe complications. One rare, serious postoperative problem is gastrobronchial fistula, which poses diagnostic and management challenges because of subtle presentation and nonspecific respiratory symptoms. A 36-year-old woman developed recurrent bronchopulmonary infections, with imaging confirming a GBF from 2017. Endoscopic stenting failed due to migration, requiring complex surgical repair, after which recovery was uneventful.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages13

Reading Time33 min

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Abstract

Background

Case Presentation

Discussion

Conclusion

Introduction

Obesity and rationale for bariatric surgery

CASE REPORT Case Report: Gastro-bronchial fistula complicating a sleeve gastrectomy: from a glimmer of hope to a plight [version 1; peer review: 2 approved with reservations] Adala Mourad 1, Adala Ahmed 1, Siala Rakia2, Mseddi Mohamed Ali 2, Yaakoubi Chaima 2, Ben Radhia Bechir 1, Amara Amal 2, Sallemi Karim2, Guizeni Rami 2, Ghariani Brahim2, Sassi Karim2, Ben Slima Mohamed2 1Centre de chirurgie de l’obésité et du diabète de Tunis, Tunis, Tunisia 2general surgery "B", Rabta Hospital, Tunis, Tunis, Tunisia v1 First published: 19 Sep 2025, 14:948 [https://doi.org/10.12688/f1000research.169504.1](https://doi.org/10.12688/f1000research.169504.1) [Latest published:](Latest published: 08 Dec 2025)[ 08 Dec 2025](Latest published: 08 Dec 2025), 14:948 [https://doi.org/10.12688/f1000research.169504.2](https://doi.org/10.12688/f1000research.169504.2) Abstract Background Bariatric surgery, particularly sleeve gastrectomy (SG), has emerged as an effective long-term treatment for morbid obesity. Despite its benefits, howver, it may result in severe complications. One rare but serious postoperative issue is the development of a gastrobronchial fistula (GBF), a condition with a challenging diagnosis and management pathway due to its insidious nature. Case Presentation We report the case of a 36-year-old woman who underwent sleeve gastrectomy in 2015. The early postoperative course was complicated by a gastric fistula that was managed with double pigtail stents. Subsequently, the patient developed recurrent bronchopulmonary infections, and imaging in 2017 revealed a GBF connecting the gastric remnant to the bronchial tree. Initial endoscopic management with stenting failed because of migration. Definitive surgical management involved complex adhesiolysis and creation of tension-free fistulajejunal anastomosis. Postoperative recovery was uneventful, and the patient remains asymptomatic. Discussion Gastrothoracic fistula post-bariatric surgery is a rare but potentially life-threatening complication. Their development is often linked to the Open Peer Review | Approval Status | | | --- | --- | | 1 | 2 | | version 2
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08 Dec 2025
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19 Sep 2025 | | 1. Mohamed Hany, Alexandria University, Alexandria, Egypt 2. Vusal Aliyev, Alibey Hospital, Istanbul, Turkey Any reports and responses or comments on the article can be found at the end of the article. insufficient treatment of early gastric leaks or collections. Diagnosis is frequently delayed owing to nonspecific respiratory symptoms. Endoscopic approaches have show limited success, and surgical management, often complex, is frequently necessary. Multidisciplinary strategies, including endoscopic and surgical options, are vital for achieving favorable outcomes. Conclusion Gastrobronchial fistulas represent a diagnostic and therapeutic challenge following sleeve gastrectomy. A high index of suspicion, long-term follow-up, and tailored multidisciplinary approach are essential for effective management and resolution. Awareness of this rare complication should prompt early detection and intervention to reduce the morbidity and mortality. Keywords sleeve gastrectomy, gastrobronchiol fistula, bariatric surgery Corresponding author: Mseddi Mohamed Ali ([mseddibaka@gmail.com](mseddibaka@gmail.com)) Author roles: Mourad A: Data Curation, Validation; Ahmed A: Supervision; Rakia S: Supervision, Validation; Mohamed Ali M: Writing – Original Draft Preparation, Writing – Review & Editing; Chaima Y: Validation; Bechir BR: Supervision; Amal A: Supervision; Karim S: Supervision; Rami G: Supervision; Brahim G: Supervision; Karim S: Supervision; Mohamed BS: Validation, Visualization Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Mourad A et al. This is an open access article distrib

FAQs

What complication does the case report focus on after sleeve gastrectomy?

The report focuses on a gastrobronchial fistula complicating sleeve gastrectomy. It is presented as rare but potentially life-threatening.

How did the diagnosis and management progress in the described patient?

After recurrent bronchopulmonary infections, imaging in 2017 revealed a fistula connecting the gastric remnant to the bronchial tree. Initial endoscopic stenting failed due to migration, and definitive surgery required complex adhesiolysis and tension-free fistulojejunal anastomosis.

Why is gastrobronchial fistula challenging to diagnose after bariatric surgery?

Diagnosis is often delayed because respiratory symptoms can be nonspecific and insidious. Endoscopic approaches may show limited success, so multidisciplinary strategies including surgical management are frequently needed.

Sep 28, 2026

Uploaded by Stanley