A 55-year-old male with grade II obesity (weight 94.5 kg, BMI 36 kg/m2), hypertension, hypercholesterolemia and type 2 diabetes mellitus (T2DM) treated with 2 oral antidiabetics of insulin (ADO)
After a multidisciplinary assessment, the decision was made to perform endoscopic placement of an Endoscope®. The procedure was uneventful.
The patient attends the 4-week review and is in good condition, having lost 7.5 kg of weight and reducing the needs of OAD and insulin by half.
A week later fever and abdominal pain appeared.
It is done:
Physical restraint: defense in right hypochondrium with positive Murphy's sign.
- Analytical: leukocytosis (L: 21,000/ul with left shift).
- abdominal CT: acute emphysematous ductus arteriosus with cystic air bubbles and aerial level in the gallbladder, correctly placed in the endoscope®.
Laparoscopic cholecystectomy was performed, finding an acute vesicular impaction due to penetration secondary to transmural bulbar penetration and one of the plugs of the endoscopic cholecystectomy®.
The primary pathology confirmed acute meningitis with positive bile cultures for Clostridium perfringens.
The initial seizure post-surgical torpid with abdominal defense, so a transit is performed showing a small duodenal fistula well collected by drainage.
Gastroscopy confirmed the small bulbar fistulous orifice, so it was decided to remove the Endoscope® without incidents.
The subsequent evolution with conservative medical treatment is satisfactory, and the patient was discharged after 10 days.
