138: GASTRIC ANASTOMOTIC FISTULA TREATMENT WITH ENDOSCOPIC SPONGE VACUUM ASPIRATION SYSTEM IN A MULTIVISCERAL TRANSPLANTATION CASE

Introduction: The upper gastrointestinal anastomoses of a multivisceral graft may suppose a problem sometimes. The trend in recent years has been to preserve a portion of native stomach if possible. Nevertheless, the gastro-gastric anastomoses may also leak. We present one of these cases where the final treatment consisted on endoscopic sponge vacuum aspiration. Material and methods. Case presentation: A 30 years old man who received a multivisceral transplant plus kidney and native spleen preservation with splenocaval venous anastomosis, due to short bowel syndrome after volvulus treatment 11 years before, with home parenteral nutrition since the n. Type I diabetes since 4 years old, badly controlled, with end-stage renal failure in dyalisis since 3 years before. Acute myocardial infarction one year before, with pharmacoactive stent. Liver hematoma after a biopsy, with embolization. Tricuspideal endocarditis with pulmonary septic embolization and pleural effusion. Cerebellar hematoma during hypertensive crisis. Cardiogenic/distributive mixed shock 2 years before without positive culture, with intubation and continuous venovenous hemodiafiltration. Moderate-severe mixed axonal demyelinating peripheral polyneuropthay. He had a prolonged transplant, 15 hours, with 12 packed red cells and 6 fresh frozen plasma units transfusion and 5 fibrinogen grams. Postoperative dyalisis. Extubated after 24 hours. Immunosuppression with thymoglobulin, tacrolimus and steroids. Discharged 8 days after from the ICU. Three days after he presented an acute abdomen due to gastric anastomotic leak, with shock and aspiration, with multiorgan failure. Surgically treated, he was transferred to the ICU. Four days later reoperated for splenic infarction. Fifteen days after gastric leak he showed a new leak. An endoscopic sponge vacuum treatment was decided. Results: Treatment started 2 days after the diagnosis of reperforation. The perforation measured around 1 cm in diameter. A Hanaro type TTS 8 cm prosthesis was placed. But it did not control the situation, with ongoing bile leak shown by the neighbouring abdominal drain, and 56 days after the prosthesis was removed, and a sponge vacuum procedure was initiated. The device was changed every 3 days. The drainage decreased with time and the perforation progressively healed, with the device being removed after 15 days, and nasojejunal tube installed for nutrition. A trophic nutrition was initiated and progressively the flow increased, combined with parenteral nutrition. Discharge from the ICU was on 131st day, due to the severely complicated general condition and the COVID-19 pandemic that affected the hospital management. Conclusion: A sponge vacuum endoscopic device may be an effective treatment in cases of gastro-gastric anastomoses leakage in multivisceral transplantation