Mohammed Hamad Alrashedi
Staple-line leak (SLL) following laparoscopic sleeve gastrectomy (LSG) carries significant morbidity and, when diagnosis is delayed, can be life-threatening, occurring in a small but clinically important proportion of patients undergoing the procedure. Despite advances in bariatric surgery, management of post-LSG leaks remains challenging and often requires a multidisciplinary approach involving surgery, interventional radiology (IR), gastroenterology, and infectious disease specialists. We report a 39-year-old medically free male who presented to our emergency department 10 days following LSG performed in Egypt, with a three-day history of progressive epigastric pain, nausea, vomiting, and fever. Imaging revealed an 18 × 12.5 × 12 cm perigastric collection with an air-fluid level consistent with a staple-line leak. The patient was managed in the ICU with broad-spectrum antibiotics, bowel rest, and percutaneous pigtail drainage. A follow-up CT scan confirmed active oral contrast extravasation from the superior residual stomach. Due to the unavailability of an endoscopic mega-stent at our institution, the patient was transferred to an advanced bariatric center, where successful endoscopic mega-stent insertion was performed on postoperative day 19. The stent was removed 78 days later without complications. At the eight-month follow-up, the patient was asymptomatic, with a weight of 68 kg (BMI 23.85 kg/m²), representing approximately 86% excess weight loss, an excellent functional and metabolic outcome. This case highlights the critical importance of early radiologic diagnosis, prompt percutaneous drainage, stepwise escalation of antibiotic therapy, and timely access to advanced endoscopic intervention in managing post-LSG staple-line leaks. Institutional capacity to deploy endoscopic mega-stents and established interhospital referral pathways are key determinants of outcome.