Bariatric Surgery Patient Develops Sepsis And Dies

Case Overview

This case takes place in North Dakota and involves a 70-year-old male patient, with a past medical history of morbid obesity, who underwent placement of a Stomaphyx device (endoluminal gastric pouch reduction. About a year later, the Stomaphyx device was removed. Six months later, he underwent upper endoscopy and a large perforation of the esophagus was noted. This was treated non-operatively by esophageal stenting. A series of endoscopies was needed to properly place the stents. Despite what was thought to be adequate placement, he developed evidence of mediastinitis and then an aorto-esophageal fistula. This, too, was treated non-operatively, but eventually an esophageal resection was performed. Despite continued treatment, he developed sepsis and died.

Questions to the General Surgery expert and their responses

How often do you perform these procedures?

I frequently perform these types of procedures, typically on a weekly basis. Before the Stomaphyx device was taken off the market, I performed over 100 surgeries using the device.

Have you ever encountered the complications that this patient suffered?

I never had a patient encounter this complication. I have, however, treated patients who suffered perforations following this therapy and have been deposed as a treating physician in those cases. Complications like these may be why the Stomaphyx device was taken off the market.

Is it common to fail to recognize an esophageal perforation during endoscopy?

It really depends on the size of the perforation. However, the symptoms usually manifest themselves within 24-36 hours. It is very odd that this one was missed for so long.

About the expert

This highly qualified Bariatric Surgery and Surgical Endoscopy expert received his medical degree from the university of Missouri. He went on to complete a Residency in General Surgery and Fellowship in Advanced Laparoscopy and Endoscopy at the prestigious Cleveland Clinic Foundation. He is board certified by the American Board of Surgery. This expert is President of the Ohio Society of Bariatric Surgery and is a member of numerous professional organizations such as the American Society of Metabolic and Bariatric Surgery. He has published 144 peer-reviewed journal articles and authored a textbook on Minimally Invasive Surgery and 27 book chapters. He is frequently invited to lecture as a guest speaker at engagements both nationally and internationally.