Malpositioned gastric band causing pouch obstruction and ischemia
Has had laparoscopic gastric band in situ for 10 years. Now sudden onset of epigastric pain and vomiting.
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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 edematous swelling of the gastric wall and inflammation in the adjacent fat. Appearances suggest at least venous ischemia of the proximal stomach requiring removal of the band.
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 ischemia leading to marked mural edema.
- Mehanna MJ, Birjawi G, Moukaddam HA et-al. Complications of adjustable gastric banding, a radiological pictorial review. AJR Am J Roentgenol. 2006;186 (2): 522-34. AJR Am J Roentgenol (full text) - doi:10.2214/AJR.04.0655 - Pubmed citation