Gastric band overinflation

Case contributed by Dr Ghufran Aref Saeed

Presentation

History of recent adjustment of gastric band, now with epigastric abdominal pain, vomiting, heartburn, and difficulty swallowing especially when food reaches distal esophagus.

Patient Data

Age: 30-35 years
Gender: Male
X-ray

Radiograph of the abdomen shows normal position of the gastric band with normal phi angle. There is a bulging band balloon, however.

No intestinal obstruction or pneumoperitoneum.

CT

CT scan of the abdomen with IV contrast reveals dilatation of the distal esophagus and proximal pouch of the stomach with air-fluid level, compatible with overinflation of the gastric band.

Fluoroscopy

Post deflation image of the gastric band showed smooth passage of contrast into the stomach with resolved dilatation of the proximal gastric pouch and distal esophagus.

Case Discussion

Laparoscopic adjustable gastric banding (LAGB) can be associated with early and late complications.

Early complications might include malpositioning of the band, infection, or gastric perforation.

Examples of delayed complications include pouch dilatation, esophageal dilatation and dysmotility, gastro-esophageal reflux, band slippage, intragastric erosion, disconnection of components, port-site infection, and small bowel obstruction.

Radiologic imaging is essential to identify the position and complications of LAGB. Different modalities can be used, depending on the diagnostic need and availability.

In this study, esophageal dilatation and subsequent gastroesophageal reflux were due to narrowing of the gastro-esophageal junction due to band overinflation.

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