A rare presentation of gastro-pleural fistula after Roux-en-Y gastric bypass, simultaneous fistula of gastric pouch, and remnant to the pleural space.

Key Clinical Message: Although gastro-pleural fistulas after bariatric surgeries are rare, they are life-threatening complications that should be suspected in patients who present with gastrointestinal or respiratory symptoms after bariatric surgery. Abstract: Previous studies showed an incidence rate of 0.2%-0.37% for gastro-pleural fistulas after bariatric surgery. We report a 56-year-old female with a rare presentation of gastro-pleural fistula after Roux-en-Y gastric bypass, simultaneous fistula of the gastric pouch, and remnant to the pleural space.