Malpositioned gastric band causing pouch obstruction and ischaemia

Case contributed by Dr Chris O'Donnell

Presentation

Has had laparoscopic gastric band in situ for 10 years. Now sudden onset of epigastric pain and vomiting.

Patient Data

Age: 45
Gender: Female

The phi angle (angle subtended by the vertebral column and lap band) is approximately 90 degrees (it should be about 55 degrees) indicating that the band has slipped distally and is causing distension of the proximal stomach including oedematous swelling of the gastric wall and inflammation in the adjacent fat.  Appearances suggest at least venous ischaemia of the proximal stomach requiring removal of the band.

Case Discussion

It is important to assess the position and orientation of lap bands when viewing radiographs or CT.  The most useful measurement is the phi angle ie angle subtended by the vertical column and band in profile.  It should be between 4 and 55 degrees.  If greater than this, the band has slipped.  ON x-ray the band should always be seen in profile.  If the band is seen as an ovoid/circle then it has rotated in position.  This is always abnormal.  If the band moves it can cause obstruction to the proximal stomach and even erose into the lumen.  In this case then is obstruction to the proximal stomach and probable venous ischaemia leading to marked mural oedema.

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Case information

rID: 41913
Case created: 26th Dec 2015
Last edited: 23rd Nov 2016
Inclusion in quiz mode: Included

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