Slipped gastric band

Case contributed by Dr Craig Hacking

Presentation

Acute epigastric pain, nausea and vomiting. Previous gastric lap band.

Patient Data

Age: 40 years
Gender: Female
X-ray

Gastric band alignent is different in the two projections and abnormally horizontal in the erect projection suggesting slippage. No features to suggest perforation.

Cholecystectomy. Gasless small bowel most likely reflects vomiting. A small amount of gas is seen in non-distended colon.

CT

Lap band device noted in situ. The phi angle measures 60 degrees. There is no extraluminal contrast extravasation from the well distended stomach. No surrounding stranding.

There is no free fluid or free gas.

Evidence of previous cholecystectomy is noted. The liver, spleen, adrenal glands and pancreas are normal in appearance. Mild prominence of the common bile duct is likely secondary to previous cholecystectomy. Small hypodense renal lesions are most likely cysts however these are too small to be adequately assessed on this study. Presumed previous hysterectomy. The surgical clip projected within the left hemipelvis likely secondary to prior tubal ligation. No bowel abnormality.

Apart from mild atelectasis, the lung bases are clear.

Conclusion

Findings are most consistent with collapse and slippage with the phi angle measuring 60 degrees;. No CT evidence of extraluminal contrast extravasation from the stomach. No other potential cause for the patient's pain is identified.

Fluoroscopy

Barium swallow

Barium Swallow

Technique:

Barium swallow was performed with the patient in the erect position, initially with liquid barium, then with barium-soaked bread.

Preliminary screening fluoroscopy shows gastric lap band oriented closer to horizontal than to vertical with a gas bubble proximal to it. Delayed transit was observed through the oesophagus during both liquid and solid components of the study. Contrast outlines a small pouch proximal to the lap band. Contrast and food material passes through the lap band into the body of the stomach.

Conclusion

Slipped gastric lap band with proximal pouch formation. Delayed oesophageal transit to both solids and liquids.

Case Discussion

Slippage is one of the more common complications of gastric banding.

PlayAdd to Share

Case information

rID: 40146
Case created: 9th Oct 2015
Last edited: 27th Sep 2017
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.