Clinical Picture
Acute gastric band slippage Marco Barreca, Joseph Shalhoub
A 25-year-old woman came to the accident and emergency department with a 12-h history of sudden onset regurgitation and complete dysphagia. She had had gastric banding in 2008, for morbid obesity. A plain chest radiograph showed an abnormal appearance of the gastric band (figure). Normally, a gastric band appears as a single radioopaque bar lying diagonally, at 40–50 degrees to the vertebral column. When a gastric band slips, part of the gastric fundus herniates through the band, initially causing the A
left side of the band to move caudally and subsequently forcing the anterior part of the band further caudally; an annular appearance of the band results (figure). On the basis of the history and this radiographic finding, the band was deflated in the emergency department, and the patient was given urgent laparoscopic band removal. With the increase in obesity surgery it is important to highlight such complications, as emergency deflation and band removal is necessary to prevent necrosis of the herniated stomach. B
Published Online January 3, 2014 http://dx.doi.org/10.1016/ S0140-6736(13)60998-8 Department of Surgery, Luton and Dunstable University Hospital, Luton, UK (M Barreca FRCS, J Shalhoub MRCS) Correspondence to: Mr Marco Barreca, Luton and Dunstable University Hospital, Lewsey Road, Luton LU4 0DZ, UK [email protected]
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Figure: Gastric band slippage (A) Plain chest radiograph showing gastric band in the correct position. (B) O-shaped configuration of gastric band with air-fluid level just above the band. (C) Intraoperative photograph confirming band slippage.
www.thelancet.com Published online January 3, 2014 http://dx.doi.org/10.1016/S0140-6736(13)60998-8
1
Acute gastric band slippage Marco Barreca, Joseph Shalhoub
A 25-year-old woman came to the accident and emergency department with a 12-h history of sudden onset regurgitation and complete dysphagia. She had had gastric banding in 2008, for morbid obesity. A plain chest radiograph showed an abnormal appearance of the gastric band (figure). Normally, a gastric band appears as a single radioopaque bar lying diagonally, at 40–50 degrees to the vertebral column. When a gastric band slips, part of the gastric fundus herniates through the band, initially causing the A
left side of the band to move caudally and subsequently forcing the anterior part of the band further caudally; an annular appearance of the band results (figure). On the basis of the history and this radiographic finding, the band was deflated in the emergency department, and the patient was given urgent laparoscopic band removal. With the increase in obesity surgery it is important to highlight such complications, as emergency deflation and band removal is necessary to prevent necrosis of the herniated stomach. B
Published Online January 3, 2014 http://dx.doi.org/10.1016/ S0140-6736(13)60998-8 Department of Surgery, Luton and Dunstable University Hospital, Luton, UK (M Barreca FRCS, J Shalhoub MRCS) Correspondence to: Mr Marco Barreca, Luton and Dunstable University Hospital, Lewsey Road, Luton LU4 0DZ, UK [email protected]
C
Figure: Gastric band slippage (A) Plain chest radiograph showing gastric band in the correct position. (B) O-shaped configuration of gastric band with air-fluid level just above the band. (C) Intraoperative photograph confirming band slippage.
www.thelancet.com Published online January 3, 2014 http://dx.doi.org/10.1016/S0140-6736(13)60998-8
1
