A Gastrobronchial Fistula Secondary to Endoscopic Internal Drainage of a Post-Sleeve Gastrectomy Fluid Collection.

A 44-year-old woman underwent sleeve gastrectomy, which was complicated by a leak. She was treated with two sessions of endoscopic internal drainage using plastic double-pigtail stents. Her clinical evolution was favorable, but four months after the initial stent placement, she became symptomatic, and a gastrobronchial fistula with the proximal end of the stents invading the diaphragm was diagnosed. She was treated with antibiotics, plastic stents were removed, and a partially covered metallic esophageal stent was placed. Eleven weeks later, the esophageal stent was removed with no evidence of fistula. Inappropriate stent size, position, stenting duration, and persistence of low-grade inflammation could explain the patient's symptoms and provide a mechanism for gradual muscle rupture and fistula formation. Although endoscopic internal drainage is usually safe and effective for the management of post-laparoscopic sleeve gastrectomy leaks, close clinical and radiological follow-up is mandatory.

Lateral duodenal wall perforation due to plastic biliary stent migration: a case series of endoscopic closure.

Background and study aims Lateral duodenal wall perforation by a migrated stent is a potential complication of biliary stenting. By systematic database revision, we identified a series of six patients with lateral duodenal wall perforation caused by a displaced plastic biliary stent that were treated with over-the-scope clip (OTSC) between January 1, 2014 and March 31, 2019. In this series, most cases were related to stenting of benign strictures with single or double stenting and with the use of stents longer than 12 cm. OTSC permitted perforation closure in all cases. Most patients had an excellent outcome and did not need any subsequent intervention. However, one patient, who presented with a more severe pneumoretroperitoneum on computed tomography scan, required laparotomy with peritoneal lavage and eventually died due to this complication. We conclude that endoscopic treatment of these perforations with OTSC could be an effective alternative to surgery in selected patients.

Effectiveness of electrooxidation process for stabilizing and conditioning of urban and industrial wastewater sludge.

The objective of this research was to investigate the performance of an electrochemical process for enhancing dewaterability and stabilize wastewater sludge from paper mill industry (PMS) and municipal wastewater (MWS) treatment plants. The treatment was conducted using 13.2 kg of sulfuric acid (H2SO4) per ton of dry sludge (TDS) and 200 kg of NaCl/tds as electrolytes, at a current intensity of 8A for 60 min. The process was efficient for increasing the dryness of PMS with an average value of 25.3 +/- 1.2% (w/w). By comparison, the electrochemical treatment using MWS allowed increasing the dryness to 33.4 +/- 1.4% (w/w). Simultaneously, the process was found to be effective in removing pathogen indicators (abatement > 4 to 5 log units of total and fecal coliforms) using either PMS or MWS. At the same time, it preserved the fertilizing properties of sludge by maintaining the concentration of P(tot), N-TKN and COD in dewatered sludge. The substitution of sodium chloride (used as electrolyte) by sodium sulfate (Na2SO4) combined with hydrogen peroxide (H2O2) allowed reducing the formation of organo-chlorinated compounds: more than 50% of chloroform was reduced, 86% of toluene was reduced and 59% of phenolic compounds was reduced.