Novel minimally invasive management of gastric–diaphragmatic–pleural–bronchial fistula following sleeve gastrectomy: a case report

Introduction and importance: Gastro-pleuro-bronchial fistula is a rare but severe complication following bariatric surgery. This report highlights a novel, minimally invasive, staged interventional approach for managing such complex fistulas when conventional treatments fail. Case presentation: An 18-year-old female with metabolic syndrome developed a gastro-diaphragmatic-pleural-bronchial fistula after laparoscopic sleeve gastrectomy, presenting with persistent vomiting, coughing, and sputum production. Imaging and endoscopy confirmed the diagnosis. Clinical discussion: After unsuccessful surgical revisions and conservative therapy, a stepwise interventional strategy was employed. First, a gastrostomy balloon was placed for temporary fistula occlusion and drainage. Subsequently, the abdominal fistula tract was embolized using spring coils and a tissue glue-iodized oil mixture to seal the bronchial communication. Final definitive closure was achieved with endoscopic titanium clip suturing. Conclusion: This case demonstrates the successful management of a complex post-bariatric fistula through a tailored, multi-stage interventional radiology and endoscopic approach. It presents a viable and less invasive alternative to repeated major surgery in selected cases.