Complex Management of a Persistent Gastropleural Fistula With Necrotic Left Lower Lobe of the Lung Following Bariatric Surgery: A Case Report

Gastropleural fistula is a rare but serious complication characterised by an abnormal communication between the stomach and the pleural cavity. It poses substantial diagnostic and therapeutic challenges and often requires coordinated multidisciplinary intervention. We report the case of a 52-year-old woman with a complex surgical history, including multiple bariatric procedures, who developed a persistent gastropleural fistula complicated by necrosis of the left lower lung lobe. Multiple endoscopic interventions, including Ovesco clip placement and fibrin glue injection, were unsuccessful in achieving fistula closure. Clinically, she presented with a chronic productive cough yielding greenish sputum, along with coarse crepitations localised to the left lower lung zone. Imaging demonstrated a left-sided pleural effusion, prompting further evaluation. Contrast-enhanced CT of the chest and abdomen revealed a patent fistulous tract communicating with the proximal gastric body and extensive left lower lobe necrosis. Surgical management included left lower lobectomy, circumferential dissection, and identification of the gastropleural fistula, transposition of the fistulous tract into the abdominal cavity, and primary diaphragmatic repair to prevent continued leakage into the thoracic cavity. Following surgery, the patient was transferred to a specialised upper gastrointestinal centre for ongoing care and definitive fistula management. This case highlights the profound impact gastropleural fistulas can have on pulmonary structures and underscores the complexity of their management. It emphasises the necessity of a multidisciplinary approach integrating thoracic and upper gastrointestinal surgical expertise to optimise outcomes.