A Case of Gastric Perforation due to Large Lap-Band Erosion Presenting with Severe Crushing Chest Pain

Abstract

Purpose: Gastric lap band surgery is a common procedure done for the treatment of morbid obesity. We present a case of large lap band erosion with gastric perforation presenting to the emergency room as severe crushing chest pain. A very pleasant 67-year-old Caucasian female with hx of hypertension, coronary artery disease, diabetes mellitus, hx of right nephrectomy for renal cancer, hx of lap band surgery 2 years ago for the treatment of morbid obesity presented to the emergency room with severe crushing chest pain. Chest X ray, electrocardiogram and cardiac enzymes were ordered and were found to be within normal limits. A gastroenterology consultation was requested and an upper endoscopy was performed which revealed a large gastric erosion in the gastric cardiac with almost half of the lap-band eroding into the stomach creating a contained perforation in the gastric wall. Surgical consultation was requested immediately and patient underwent laproscopic surgery with removal of the lap band and closure of the perforated site with figure of -8 Vicryl sutures. Follow-up gastroffin study 24 hours later did not reveal extravasation of contrast. Patient felt much better and had resolution of symptoms. Conclusion: In patients who have had lap band surgery, complications from lap band placement should be considered in the differential diagnosis of acute chest pain syndromes.Figure: Large lap-band erosion, just beneath the esophagogastric junction.Figure: Retroflexed view of the esophagogastric junction.Figure: No Caption available.