Gianfranco Donatelli1, Jean-Loup Dumont2, Fabrizio Cereatti3, Bruto Randone4, Bruno Meduri2, Panagiotis Lainas5,6, Hadrien Tranchart5,6, Ibrahim Dagher5,6. 1. Department of Interventional Endoscopy, Peupliers Private Hospital, Ramsay Générale de Santé, 8 Place de l'Abbé G. Hénocque, 75013, Paris, France. donatelligianfranco@gmail.com. 2. Department of Interventional Endoscopy, Peupliers Private Hospital, Ramsay Générale de Santé, 8 Place de l'Abbé G. Hénocque, 75013, Paris, France. 3. Unit of Gastrointestinal Endoscopy and Gastroenterology, ASST Cremona, Cremona, Italy. 4. Department of Digestive Surgery, Hôpital Privé d'Antony, Ramsay Générale de Santé, 92160, Antony, France. 5. Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, (AP-HP), 92140, Clamart, France. 6. Paris-Saclay University, 91405, Orsay, France.
Abstract
INTRODUCTION: Postoperative collections are an important cause of morbidity following obesity surgery. Surgical revision is most often required if general sepsis is present. Conservative treatment consists of broad spectrum antibiotics and percutaneous drainage of any collection. EUS drainage is a new technique that is gaining momentum allowing an easy access to collections close to the GI tract. MATERIALS AND METHODS: We present the case report of a 39-year-old woman who underwent to robotic Roux-en-Y gastric bypass for morbid obesity. She developed a jejuno-jejunal dehiscence treated with revision surgery. Afterward, a pelvic collection/hematoma was highlighted; however, neither percutaneous approach nor surgery succeeded in draining it. RESULTS: EUS-guided deployment of a fully covered lumen-apposing metal stent was performed. Subsequently, two necrosectomies were required to remove necrotic tissue and clots from the perirectal cavity. Finally, three double pigtail stents were deployed to promote healing. The patient spontaneously expelled the stents with the stool, and she is asymptomatic after a follow-up of 3 months. CONCLUSION: EUS transmural rectal drainage may represent a sound option for the treatment of pelvic postoperative collections. FCLAMS deployment guarantees a rapid drainage allowing to perform an endoscopic necrosectomy.
INTRODUCTION: Postoperative collections are an important cause of morbidity following obesity surgery. Surgical revision is most often required if general sepsis is present. Conservative treatment consists of broad spectrum antibiotics and percutaneous drainage of any collection. EUS drainage is a new technique that is gaining momentum allowing an easy access to collections close to the GI tract. MATERIALS AND METHODS: We present the case report of a 39-year-old woman who underwent to robotic Roux-en-Y gastric bypass for morbid obesity. She developed a jejuno-jejunal dehiscence treated with revision surgery. Afterward, a pelvic collection/hematoma was highlighted; however, neither percutaneous approach nor surgery succeeded in draining it. RESULTS: EUS-guided deployment of a fully covered lumen-apposing metal stent was performed. Subsequently, two necrosectomies were required to remove necrotic tissue and clots from the perirectal cavity. Finally, three double pigtail stents were deployed to promote healing. The patient spontaneously expelled the stents with the stool, and she is asymptomatic after a follow-up of 3 months. CONCLUSION: EUS transmural rectal drainage may represent a sound option for the treatment of pelvic postoperative collections. FCLAMS deployment guarantees a rapid drainage allowing to perform an endoscopic necrosectomy.
Authors: Carmel G Cronin; Debra A Gervais; Carlos Fernandez-Del Castillo; Peter R Mueller; Ronald S Arellano Journal: AJR Am J Roentgenol Date: 2011-07 Impact factor: 3.959
Authors: Reem Z Sharaiha; Amy Tyberg; Mouen A Khashab; Nikhil A Kumta; Kunal Karia; Jose Nieto; Uzma D Siddiqui; Irving Waxman; Virendra Joshi; Petros C Benias; Peter Darwin; Christopher J DiMaio; Christopher J Mulder; Shai Friedland; David G Forcione; Divyesh V Sejpal; Tamas A Gonda; Frank G Gress; Monica Gaidhane; Ann Koons; Ersilia M DeFilippis; Sanjay Salgado; Kristen R Weaver; John M Poneros; Amrita Sethi; Sammy Ho; Vivek Kumbhari; Vikesh K Singh; Alan H Tieu; Viviana Parra; Alisa Likhitsup; Craig Womeldorph; Brenna Casey; Sreeni S Jonnalagadda; Amit P Desai; David L Carr-Locke; Michel Kahaleh; Ali A Siddiqui Journal: Clin Gastroenterol Hepatol Date: 2016-05-14 Impact factor: 11.382
Authors: Hussam I A Alzeerelhouseini; Muawiyah Elqadi; Mohammad N Elqadi; Sadi A Abukhalaf; Hazem A Ashhab Journal: Case Rep Gastrointest Med Date: 2021-04-02