A 13-year journey of a gastric band – ultimate destination terminal jejunum: a case report

Abstract

BackgroundLaparoscopic adjustable gastric banding has been the gold standard for surgical management of obesity over the last decades in USA and Europe. However, significant complications have been documented due to foreign body placement, including band erosions. Our treatment approach for erosions is rather observant with regular follow-up until the band has sufficiently perforated the gastric wall which facilitates endoscopic removal. Consequences of a not followed-up band erosion may present even after a long time following initial diagnosis with more severe complications.Case presentationA 51-year-old Caucasian woman presented to our out-patients’ clinic with a 2-week history of worsening abdominal pain in her left upper quadrant, exacerbated by abdominal flexion and extension maneuvers.Here we describe a case involving gastric penetration and subsequent downward migration of a band into distal jejunum causing small bowel obstruction, which occurred more than 10 years following initial diagnosis of erosion. The perforation was missed due to cessation of endoscopic follow-up.ConclusionProspective and long-term follow-up is mandatory in those with partial band erosion to avoid further complications.

Unexpected Gastrointestinal Tract injury years following Laparoscopic Adjustable Gastric Banding

“…Of importance in the present case is that the migration was diagnosed 8 years prior to the admittance for acute presentation requiring surgical treatment. Same observation has been reported by Widmer et al [13] with a case of known migration 10 years before the patient required surgery for small bowel obstruction. Distal dislocation of the band may therefore occur years after the erosion and migration within the stomach.…”

“…A more recent case report described erosion 18 years after LAGB [23] . Another 2 case reports described the complications late after LAGB at 13 years [13] and at 15 years [10] as in the current case. Of importance in the present case is that the migration was diagnosed 8 years prior to the admittance for acute presentation requiring surgical treatment.…”

“…Erosion and migration of the band within the digestive lumen is one of the less frequent late complications occurring after LAGB, [9] . Moreover, migration is generally limited to the stomach and cases with distal dislocation of the band have been only a matter of case reports [10] , [11] , [12] , [13] , [14] or description of cases within case series [15] , [16] . Life threatening presentations of such distal migration of the band causing gastro-intestinal injuries are very rare [15] , [16] , [17] .…”

“…As reported in the present case, distal dislocation into the gastro-intestinal tract may complicate the erosion of the band within the stomach. Dislocation without major gastro-intestinal injuries has been reported in 3 case reports [10] , [13] , [14] , all of which had the band removed trough an enterotomy, while only 2 reported performing a gastrostomy following the enterotomy [10] , [14] . In the case reported by Widmer et al [13] , the jejunal segment was resected due to a conglomerate formation, no procedure was done on the stomach.…”

A Rare Case of an Incidental Near-Complete Gastric Band Erosion Without Perforation

“…Bariatric surgery has transitioned from an open surgical approach to a laparoscopic procedure for the treatment of morbid obesity [ 1 , 2 ]. Gastric banding was one of the most preferred when it was first introduced in 1993 because it is minimally invasive, effective, and reversible [ 3 , 4 ]. An inflatable band is placed laparoscopically below the gastro-esophageal junction to create a smaller gastric pouch [ 2 ].…”