PMC5412257_01
CT scan for chest and abdomen showing air filled tract extending from gastric pouch to left pleural cavity.
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Follow up CT scan for chest and abdomen showed air-filled tract extending from gastric pouch to left pleural cavity in keeping with GPF and interval development of mild right side pleural effusion (Fig. 1).
Gastrografin study showing the leakage of orally administered contrast media from the upper part of stomach to the adjacent part of the left sub-phrenic collection.
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Gastrografin study confirmed the leak of orally administered contrast media from the upper part of stomach to the adjacent part of the left sub-phrenic collection but the communication between stomach and pleural cavity that was reported on CT scan could not be clearly seen (Fig. 2).
Endoscopic view of the fistula opening below gastroesophageal junction and near to the anastomosis site.
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Upper GI Endoscopy showed a normal esophagus however there was a fistula opening below gastroesophageal junction near to the anastomosis site (Fig. 3).
Gastropleural fistula from the peritoneal side as appeared during laparoscopic exploration.
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Laparoscopic exploration showed extensive adhesions and complex fistulation between the gastric pouch, left sub-phrenic collection and left diaphragm (Fig. 4).
Gastropleural Fistula from the thoracic side as appeared during minithoracotomy.
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Upon release of left lobe, the fistula was seen underneath (Fig. 5) with a surgical clip inside it.