Abstract
Splenic abscess is a rare complication often associated with sleeve gastrectomy (SG) due to factors including local infections, distant infections, tumors, ischemia, and trauma, which presents substantial challenges. We report four cases of gastrosplenic fistula and/or splenic abscess after SG. Patient data, including demographics, comorbidities, diagnostic procedures, treatments, and outcomes, were recorded. Surgical techniques for SG adhered to established protocols. Four patients had a male-to-female ratio of 2:2, with an average age of 39.8 years and an average preoperative BMI of 38.9 kg/m2. All patients were readmitted due to recurrent fever and chills caused by splenic abscesses detected on CT scans, with an average admission duration of 16.5 weeks. Treatments varied from fasting and antibiotics to percutaneous drainage and surgical interventions. The average treatment duration post-diagnosis of splenic abscess was 37.25 weeks. Managing gastrosplenic fistula and/or splenic abscess is complex, underscoring the significance of prompt diagnosis and proper treatment. This highlights the need for heightened awareness among healthcare professionals to promptly recognize and manage this rare complication after SG.
This is a preview of subscription content, log in via an institution to check access.
Data Availability
The data that support the findings of this study are available on request from the corresponding author upon reasonable request.
References
Ulhaci N, Meteoğlu I, Kacar F, et al. Abscess of the spleen. Pathol Oncol Res. 2004;10(4):234–6. https://doi.org/10.1007/BF03033767.
Smyrniotis V, Kehagias D, Voros D, et al. Splenic abscess. An old disease with new interest. Dig Surg. 2000;17(4):354–7. https://doi.org/10.1159/000018878.
Kim J, Azagury D, Eisenberg D, et al. ASMBS position statement on prevention, detection, and treatment of gastrointestinal leak after gastric bypass and sleeve gastrectomy, including the roles of imaging, surgical exploration, and nonoperative management. Surg Obes Relat Dis. 2015;11(4):739–48. https://doi.org/10.1016/j.soard.2015.05.001.
Stamou KM, Menenakos E, Gomatos IP, et al. Clinical implications of sleeve gastrectomy as a source of spleen infarction or ischemia. Obes Surg. 2011;21(10):1490–3. https://doi.org/10.1007/s11695-010-0302-0.
Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery survey 2018: similarities and disparities among the 5 IFSO chapters. Obes Surg. 2021;31(5):1937–48. https://doi.org/10.1007/s11695-020-05207-7.
Buksh MM, Tallowin S, Al SA. Splenic abscess complicating bariatric surgery : a systematic review. Am Surg. 2022;88(1):28–37. https://doi.org/10.1177/0003134821991971.
Nassour F, Schoucair NM, Tranchart H, et al. Delayed intra splenic abscess: a specific complication following laparoscopic sleeve gastrectomy. Obes Surg. 2018;28(2):589–93. https://doi.org/10.1007/s11695-017-3069-8.
Montana L, Genser L, Cortes A, et al. Gastrosplenic fistula with gastrointestinal bleeding: a rare and potentially fatal complication after sleeve gastrectomy. Obes Surg. 2018;28(7):2135–9. https://doi.org/10.1007/s11695-018-3284-y.
Rosenthal RJ, International Sleeve Gastrectomy Expert Panel, Diaz AA, et al. International sleeve gastrectomy expert panel consensus statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012;8(1):8–19. https://doi.org/10.1016/j.soard.2011.10.019.
Li M, Liu Y, ** L, et al. Alterations of gastric emptying features following laparoscopic sleeve gastrectomy in Chinese patients with obesity: a self-controlled observational study. Obes Surg. 2019;29(2):617–25. https://doi.org/10.1007/s11695-018-3571-7.
Zachariah PJ, Lee WJ, Ser KH, et al. Laparo-Endoscopic Gastrostomy (LEG) decompression: a novel one-time method of management of gastric leaks following sleeve gastrectomy. Obes Surg. 2015;25(11):2213–8. https://doi.org/10.1007/s11695-015-1856-7.
Sakran N, Zakeri R, Madhok B, et al. Splenic abscess following sleeve gastrectomy: a systematic review of clinical presentation and management methods. Obes Surg. 2021;31(6):2753–61. https://doi.org/10.1007/s11695-021-05396-9.
Acknowledgements
The authors would like to thank all the involved study investigators, staffs, clinicians, nurses, and technicians for dedicating their time and skills to the completion of this study.
Funding
This study is funded by the National Key Technologies R&D Program (2015BAI13B09) and Capital Health Development and Research Key Project (2020–1-2021).
Author information
Authors and Affiliations
Corresponding authors
Ethics declarations
Ethics Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed Consent
For this type of study, informed consent does not apply.
Conflict of Interest
The authors declare no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Key Points
1. Splenic abscess, a rare complication following SG, arises from infections or ischemia in the spleen.
2. Four cases were managed, involving treatments ranging from antibiotics and drainage to splenectomy.
3. Delayed diagnosis and inadequate initial treatment of staple line leaks were common issues.
4. Prompt CT scans and appropriate treatment are crucial for managing and reducing these complications.
Rights and permissions
About this article
Cite this article
Zhang, Y., Min, Y., Liu, Y. et al. Gastrosplenic Fistula and/or Splenic Abscess: A Rare and Refractory Complication Following Sleeve Gastrectomy. OBES SURG (2024). https://doi.org/10.1007/s11695-024-07336-9
Received:
Revised:
Accepted:
Published:
DOI: https://doi.org/10.1007/s11695-024-07336-9