Chronic gastro-abdominal wall fistula with secondary massive thoracoabdominal wall abscess and costal destruction after laparoscopic gastricolithotomy: A case report.

Background: Although laparoscopic gastrolithotomy had been widely used in clinical practice, uncommon postoperative complications still require vigilance by medical staff.

Case summary: Here we report a 67-year-old man who suffered for 18 months and underwent surgery several times due to a rare and undetected complication of laparoscopic gastricolithotomy. He presented to multiple hospitals because of sustained left upper quadrant abdominal pain one month after laparoscopic gastricolithotomy due to a large gastric bezoar caused by unrestrained eating of black dates and was diagnosed with possible intercostal neuritis. Many painkillers were used to relieve his symptoms but the condition progressed. Seven months after surgery, he was hospitalized as skin ulceration occurred in the left upper abdominal wall and was subsequently diagnosed with a massive thoracoabdominal wall abscess. One year after surgery, irreversible costal destruction was demonstrated. Both lesions were finally proved to be secondary damage due to a rare chronic gastro-abdominal wall fistula related to laparoscopic gastricolithotomy and the diameter of the gastric fistula reached 2 centimeters (cm). The patient was ultimately cured but underwent multi-regional incisions and drainage of the abscess, drainage of the gastric fistula, partial gastrectomy and removal of damaged ribs, and was followed-up for more than 4 years without recurrence. It is well-known that gastric fistula usually has an acute onset and occurs early after surgery, while chronic gastro-abdominal wall fistula especially with secondary massive thoracoabdominal wall abscess and costal destruction has rarely been reported.

Conclusion: This may be the first reported case of a chronic thoracoabdominal abscess and costal destruction caused by an undetected chronic gastro-abdominal wall fistula. We believe that this is a novel type of gastric fistula and the diagnosis and treatment were challenging.