Gastrobronchial fistula after sleeve gastrectomy: clinical and radiographic findings.

We describe a patient who developed an intractable leak from the gastric sleeve after laparoscopic sleeve gastrectomy, resulting in the development of a gastrobronchial fistula. Affected individuals typically have a persistent leak from the gastric sleeve with recurrent subphrenic abscesses, and when a gastrobronchial fistula develops, these patients may present with paroxysms of coughing immediately after ingestion of solids or liquids. In the appropriate clinical setting, a barium study not only may show the leak, but also directly visualize the gastrobronchial fistula. If aggressive endoscopic dilation procedures and/or endoscopic placement of stents or clips fail to facilitate healing of the leak and fistula, these patients may require surgical intervention, with conversion of the sleeve to a Roux-en-Y gastric bypass or even a partial or total gastrectomy. The development of a gastrobronchial fistula after sleeve gastrectomy therefore can be extremely challenging to manage.