Drain erosion and gastro-jejunal fistula after one-anastomosis gastric bypass: Endoscopic occlusion by fibrin sealant

Leakage and fistula are feared complications after gastro-intestinal anastomosis. A 36-year-old female underwent an one-anastomosis gastric bypass. The 24-h routine radiological study before oral intake showed a tiny leak, which was treated by NPO and IN. fluids. After 5 days, despite output reduction, total parenteral nutrition was commenced. After 8 days, the leak remained with reduced output. It was then occluded endoscopically by fibrin glue. To our surprise, we found the drain that we had left behind the anastomosis, inside the gastric pouch. We began withdrawing the drain and occluded the defect with 4 ml Tissucol (R). After 48-h of no output, a repeat radiological study showed persistence of the leak. 6 days later, a radiological study demonstrated total closure of the leak.