Introduction:
Recent literature has suggested that the complication rate for laparoscopic adjustable gastric band (LAGB) is high, with up to 40% of patients experiencing major complications including band erosion (28%)1. We present a case of multiple enterotomies caused by LAGB erosion and migration requiring laparotomy with small bowel resection and complicated by psoas abscess.
Case:
A 68 year old male presented to the hospital with four days of abdominal pain but otherwise clinically well and a background of LAGB in 2007. An abdominal CT demonstrated a LAGB tubing passing intraluminally through the lesser curvature. The LAGB itself was situated within the lumen of the proximal jejunum. The jejunum proximal to the LAGB was distended and gave a concertinaed appearance on the axial images. There was no pneumoperitoneum.
Management was by laparoscopy, however an unexpected finding of multiple existing enterotomies was made requiring extension of the laparotomy and small bowel resection.
Discussion:
We believe that whilst cases of bowel perforation associated with LAGB erosion and migration are reported a case of multiple enterotomies has not. We believe that as the band migrated through the jejunum it reached a point where it acted as an anchor and the continued peristalsis of the bowel resulted in the unique consatinaed effect on the bowel which in turn caused the multiple ischaemic enterotomies. This same consatinaed effect on the bowel was responsible for containing the perforations and resulted in the patient appearing well clinically. It may easily have transpired that the enterotomies may have been missed and left in-situ. We believe that in cases such as this clinicians must maintain a high suspicion for bowel perforation and have a low threshold for progression to laparotomy. The post operative course of the patient was complicated and resulted in significant morbidity.