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rare potentially fatal complication of endoscopic internal drainage for sleeve gastrectomy leak Endoscopic internal drainage (EID) by means of a double-pigtail stent is increasingly used as an effective approach to management of leak and fistula following gastrointestinal (GI) surgery, particularly surgery for obesity [1–3]. Complications related to this technique include GI ulceration at the tip of the double-pigtail stent, migration into the abdominal cavity, and bleeding. A 35-year-old patient underwent endoscopic internal drainage for agastric fistula at the cardia that became evident 10 days after sleeve gastrectomy. A surgical drainage tube, placed during the gastrectomy procedure, was seen to be reaching the perigastric collection (●" Fig.1a). A 5-cm length double-pigtail stent was delivered through the fistula orifice into the collection (●" Fig.1b). A nasojejunal tube was inserted for feeding, and the patient’s recovery was uneventful. A computed tomography (CT) scan performed 4 weeks after EID showed intrasplenic migration of the double-pigtail stent with laceration of the parenchyma but no vessel injury or extravasation of contrast medium (●" Fig.2a,b). The patient was hemodynamically stable with no sepsis. The double-pigtail stent was successfully removed endoscopically without any bleeding (●" Fig.3). Injection of contrast medium showed no collection although the drainage tract was opacified (●" Fig.4a). A 7-Fr double-pigtail stent of length 5cm was placed to achieve internal drainage (●" Fig.4b). The patient’s recovery was uneventful. The surgical drainage tube was removed, and removal of the double-pigtail stent after 6 weeks was scheduled. Fig.1 Gastric fistula in a 35-year-old man, 10 days after sleeve gastrectomy. a Gastric fistula at cardia with perigastric collection and surgical drainage tube. b Endoscopically placed 5-cm double-pigtail stent.

Double-pigtail stent migration invading the spleen: rare potentially fatal complication of endoscopic internal drainage for sleeve gastrectomy leak