Woman With Abdominal Pain

Abstract

A 42-year-old woman with a history of laparoscopic adjustable gastric band (lap band) placement 8 years previously presented to the emergency department with a several-week history of progressively worsening abdominal pain, nausea, and vomiting. She exhibited diffuse abdominal tenderness to deep palpation. The patient underwent abdominopelvic computed tomography (CT) imaging (Figure 1). She was admitted to the hospital for esophagogastroduodenoscopy and laparoscopy (Figure 2).Figure 2Upper endoscopy findings. Black arrow indicates the gastric lap band, which eroded through the stomach wall.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Adjustable gastric band erosion. The abdominopelvic CT indicated that a portion of the gastric band was intraluminal, raising the suspicion for gastric wall erosion (Figure 1). Esophagogastroduodenoscopy affirmed erosion of the gastric lap band into the gastric lumen (Figure 2). Surgeons performed laparoscopic removal of the gastric band and repair of the gastric wall. Used to assist with obesity treatment, gastric band complications include band malposition or slippage, bowel obstruction, port-related infection, and gastric wall erosion or perforation.1Altieri M.S. Yang J. Telem D.A. et al.Lap band outcomes from 19,221 patients across centers and over a decade within the state of New York.Surg Endosc. 2015 Jul 23; ([Epub ahead of print])Google Scholar Gastric band removal or revision may be required in 20% of cases. Symptoms of gastric band erosion include abdominal pain followed by loss of satiety and weight regain as the band loses its ability to constrict the stomach.2Brown W.A. Egberts K.J. Franke-Richard D. et al.Erosions after laparoscopic adjustable gastric banding: diagnosis and management.Ann Surg. 2013; 257: 1047-1052Crossref PubMed Scopus (42) Google Scholar, 3Cherian P.T. Goussous G. Ashori F. et al.Band erosion after laparoscopic gastric banding: a retrospective analysis of 865 patients over 5 years.Surg Endosc. 2010; 24: 2031-2038Crossref PubMed Scopus (62) Google Scholar The rate of lap band erosion has been reduced by replacement of the traditional perigastric approach (erosion rate of 6.77%) with the pars flaccida approach (erosion rate of 1.07%), which incorporates the gastrohepatic ligament into the band.2Brown W.A. Egberts K.J. Franke-Richard D. et al.Erosions after laparoscopic adjustable gastric banding: diagnosis and management.Ann Surg. 2013; 257: 1047-1052Crossref PubMed Scopus (42) Google Scholar Management of suspected gastric band erosion involves endoscopic and laparoscopic examination, with subsequent band removal and gastric wall repair, if indicated.