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Slipped gastric band

Case contributed by Assoc Prof Craig Hacking


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

Patient Data

Age: 40 years
Gender: Female

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.


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.


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.

Barium swallow


Barium Swallow


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 esophagus 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.


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

Case Discussion

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

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