Rare complication post sleeve gastrectomy: Acute irreducible paraesophageal hernia

• Since early postoperative nausea and vomiting are fairly common, a high index of suspicion was essential for the diagnosis.
• Taking into account the asymptomatic intrathoracic sleeve migration described in the literature, thoracic cuts of the CT Scan are essential in post sleeve evaluation.
• Sleeve gastrectomy might disrupt the lower esophageal sphincter pressure and aggravate a pre-existing asymptomatic weak sphincter.
• The only other 2 reported cases occurred in the setting of a hiatal hernia. In ours no hiatal defect was observed.

IntroductionLaparoscopic sleeve gastrectomy has been accepted as a standalone effective bariatric procedure. With the increase in the number of cases done worldwide, we are witnessing the emergence of new unexpected complications.PresentationA seemingly straight forward sleeve gastrectomy was complicated by acute post-operative vomiting which was diagnosed as an acute intra thoracic migration of part of the new sleeve. Surgical repair was done, with reduction and fixation of the stomach. Patient was subsequently relieved of his symptoms and discharged.DiscussionThis is a rare complication of a relatively well studied operation. Faced with severe post operative repeated vomiting, clinical suspicion and correct use of all para-clinical tools should help delineate the cause.ConclusionWe report this case hoping to expand the existing literature on the topic and to highlight the potential role of gastrophrenic membrane dissection in the occurrence of such complication.