Work

Staged multimodal endoscopic vacuum therapy for a complex gastro-pleuro-broncho-cutaneous fistula: A case report

Year: 2026

Type: article

Abstract: BACKGROUND: Endoscopic vacuum therapy (EVT) has emerged as a secure and efficient organ-preserving option for gastrointestinal perforations, leaks, and fistulas, with high closure rates and low mortality. CASE SUMMARY: A 41-year-old woman with a history of Roux-en-Y gastric bypass and diaphragmatic repair with biological mesh developed a left-sided empyema due to a gastric pouch fistula complicated by pulmonary abscess and rib osteomyelitis. Multiple thoracic surgical interventions failed, leading to severe malnutrition and persistent pleural drainage. A complex gastro-pleuro-broncho-cutaneous fistula was diagnosed, and salvage EVT was performed using a staged approach, including percutaneous and transluminal EVT combined with bronchial endoscopic treatment. Complete fistula closure was achieved, with restoration of oral intake and significant weight gain at two-month follow-up. CONCLUSION: This case highlights the successful use of a staged multimodal EVT strategy to achieve definitive closure of a complex gastro-pleuro-broncho-cutaneous fistula.

Source: World Journal of Clinical Cases

DOI: 10.12998/wjcc.v14.i5.117850

Authors: Beanie Conceição Medeiros Nunes, Rodrigo Silva de Paula Rocha, Tyler M Berzin, Matheus Cavalcante Franco, Angelo So Taa Kum

Institutions: Universidade de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Beth Israel Deaconess Medical Center, Harvard University, The University of Texas at San Antonio Health Science Center

Language: English

Topic: Pleural and Pulmonary Diseases

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond