Malpositioned gastric band causing pouch obstruction and ischemia
Presentation
Laparoscopic gastric band in situ for 10 years. Now sudden onset of epigastric pain and vomiting.
Patient Data
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.
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 i.e. the angle subtended by the vertical column and band in profile. It should be between 4 and 55 degrees. If it is greater 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, there is an obstruction to the proximal stomach and probable venous ischemia leading to marked mural edema.
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