Endgames Case Review

Odynophagia and vomiting eight years after laparoscopic adjustable gastric banding

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1902 (Published 16 April 2015) Cite this as: BMJ 2015;350:h1902
  1. Sara Renshaw, foundation year 2 doctor1,
  2. Borzoueh Mohammadi, consultant upper gastrointestinal surgeon1
  1. 1University College London Hospital, London NW1 2BU, UK
  1. Correspondence to: S Renshaw sararenshaw{at}nhs.net

A 51 year old woman presented with a two day history of odynophagia, followed by two days of vomiting after eating solids and subsequently also after drinking liquids. These symptoms were not accompanied by dysphagia, reflux symptoms, or change in bowel habit. A laparoscopic gastric band insertion eight years earlier had resulted in 10 kg weight loss. However, she had experienced similar symptoms four years ago, and these had resolved after deflation of the gastric band through aspiration from the subcutaneous port. She had no other medical history of note.

On examination she was tachycardic (104 beats/min) but normotensive, and she had a temperature of 37.0ºC. Her abdomen was soft and non-tender with no abdominal distension. Blood tests showed mild neutrophilia (white cell count 11.15×109/L (reference range 3-10); neutrophils 7.54×109/L (2-7.5)) and a raised C reactive protein (30.4 mg/L (0-5)), but normal liver function, renal function, calcium, and amylase. Erect chest and abdominal radiographs were performed (fig 1).

Fig 1 Abdominal radiograph with a laparoscopic adjustable gastric band in situ. Reproduced with permission from Dustin Simpson, SAMMC, Texas, USA

Questions

  • 1. What abnormality does the abdominal radiograph show?

  • 2. What are the potential risks associated with this complication?

  • 3. What immediate management should be implemented to reduce the risk of complications in these cases before transfer to a specialist bariatric unit?

  • 4. What definitive treatment options should be considered?

Answers

1. What abnormality does the abdominal radiograph show?

Answer

The gastric band has tilted along its horizontal axis so that the anterior and posterior sides of the band are no longer superimposed (fig 1). This suggests that the gastric band has slipped.

Discussion

Laparoscopic adjustable gastric banding (LAGB) creates a small gastric pouch of about 15 mL in volume. This is done by securing a silicone gastric band 2 cm below the gastro-oesophageal junction, through a …

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