Plain X-ray findings of post sleeve gastrectomy gastric leak

Gastric leak following sleeve gastrectomy (SG) is a rare but significant cause of morbidity and mortality. A high clinical index of suspicion is the most sensitive approach to detect gastric leaks. Computed tomography (CT) is the gold standard diagnostic technique, although it might not be performed due to unavailability, and the inability to image superobese patients due to limited CT gantry space. Early detection and management are critical for attaining a better prognosis. The following pictorial review discusses the various plain X-ray radiographic findings that indicate a gastric leak. These findings may be overlooked, however, they remain valuable in patients with clinically suspected gastric leaks. This pictorial review illustrates the spectrum of findings related to post-SG gastric leak encountered in plain X-ray radiography.