Septic Shock After Endoscopic Sleeve Gastroplasty: A Post-procedural Complication?

Area of Science:

• Bariatric surgery
• Minimally invasive procedures
• Obesity management

Background:

• Endoscopic sleeve gastroplasty (ESG) is a safe and effective bariatric procedure for obesity management, offering significant weight loss and metabolic improvement.
• While generally well-tolerated, ESG carries risks of procedure-related complications, including rare instances of gastric perforation.
• This case examines a patient who developed septic shock after ESG, complicated by diagnostic uncertainties.

Observation:

• A 54-year-old male with a BMI of 43.6 kg/m2 presented with severe abdominal pain, nausea, and vomiting seven days post-ESG.
• Physical examination revealed hemodynamic instability, altered consciousness, diffuse abdominal pain, and an incarcerated umbilical hernia.
• Emergent surgery was indicated due to the patient's critical condition and diagnostic uncertainties.

Findings:

• Intraoperative findings included a gastric ischemic ulcer with a mucosal defect, suggestive of gastric perforation, adhered to the abdominal wall by ESG sutures.
• The surgical team addressed a complicated umbilical hernia and performed a laparoscopic repair of the gastric defect.
• Post-operative complications included a superficial incisional surgical site infection, with the patient discharged six days after the laparoscopic procedure.

Implications:

• Endoscopic sleeve gastroplasty (ESG) is a valuable tool in obesity treatment, but awareness of potential major complications is crucial.
• Prompt diagnosis and surgical intervention are necessary for managing severe post-ESG complications like gastric perforation and septic shock.
• This case underscores the importance of vigilance for rare but serious adverse events associated with novel bariatric procedures.