Background

Sleeve gastrectomy is one of the most preformed metabolic procedures nowadays. Although relatively safe, it still carries the risk of many post-operative complications. One of the most dreadful is stapler line bleeding which can result in subsequent hematoma formation. This can in turn cause obstructive symptoms either by direct compression, or adhesions to adjacent structures. Case:This is a 49-year-old female, who underwent laparoscopic sleeve gastrectomy in December, 2022. 10 days post operatively, she presented to the Emergency Department with complaint of epigastric pain and nausea. Full workup was done, with finding of peri gastric hematoma on abdomen CT, around 8x9 cm in size. As it was not actively bleeding, patient was admitted for conservative management, then discharged 4 days later. 1 month after discharge, follow up abdomen CT was preformed, and showed regression of hematoma size to 5x6 cm. However, 2 months later, she presented to the clinic with complaint of persistent progressive food intolerance, initially to solids then liquids. Investigations including upper gastroenterology series and esophagogastroduodenoscopy were done. Due to finding of distal gastric twist and failure to clinically improve, patient was taken for diagnostic laparoscopy. Intra operative finding was of organized hematoma which caused adhesions to liver and upward pull resulting in the aforementioned symptoms. Complete take down was completed. The patient reported improvement in symptoms afterwards.

Conclusions

Although uncommon, post-operative complications such as organized hematoma should be considered as a differential in patients presenting post sleeve gastrectomy with obstructive symptoms.