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

A foreign body causing a spontaneous gastrojejunostomy in a young child

Foreign bodies in the digestive tract are a common cause of patients presenting to emergency departments. A 3-year-old boy who had accidentally swallowed magnetic beads while playing was admitted to the hospital. After failed endoscopic removal, he underwent laparoscopic removal. We found that the stomach and jejunum were tightly bound together by the magnetic beads, and this had caused perforations. The perforations had then connected to form a tract resulting in a spontaneous gastrojejunostomy. During the operation, four magnetic beads were removed from the stomach and eight from the jejunum.

Unexpected Gastrointestinal Tract injury years following Laparoscopic Adjustable Gastric Banding

•

Although most complications following LAGB are confined to the stomach and port site, some may envolve the entire bowel causing extensive damage.

•

One must be wary of the presentation of long term complications, as it may initially present as an unrelated pathology, such as acute pancreatitis.

•

Long term complications may be asymptomatic for years despite extensice damage, including multiple contained perforations.

•

The surgical procedure performed to treat long term complications should be planned and performed by physicians experienced in foregut surgery.

Introduction

Band migration is a late complication of Laparoscopic Adjustable Gastric Banding insertion, although rare it could be life threatening presenting as peritonitis secondary to gastro-intestinal tract injuries. A case of an unexpected extension of severe gastro-intestinal tract injuries secondary to intra-gastric migration and distal band dislocation is reported.

Presentation of case

A 53 years old male, with a history of laparoscopic gastric banding 15 years before and known erosion of the band into the gastric lumen was admitted for abdominal pain and raised serum amylase. Imaging revealed dislocation of the band down to the jejunum.

Endoscopy and exploratory surgery showed severe decubitus pressure on the gastric antrum up to the duodenum as well as on the pancreas due to rod-like effect of the gastric band catheter and multiple sites of perforation on distal duodenum and small bowel proximal to the band, which migrated within the lumen until 90 cm distal to the Treitz ligament. Extended distal gastrectomy and resection of distal duodenum and small bowel extended to the proximal affected small bowel were necessary. Digestive tract was restored by a gastro-jejunostomy and duodeno-jejunostomy in a Roux-En-Y configuration with duodenal stump closure on tube duodenostomy. A post-operative leakage from the duodenal stump was treated conservatively and the patient was discharged on post-operative day 21.

Discussion

Erosion and migration of the band within the digestive lumen is one of the less frequent late complications occurring after LAGB, furthermore, the amount of extensive damage reported in this case presentation has yet to be reported in literature.

Conclusion

Migration of the band should be considered in the differential diagnosis of abdominal complain in patients with adjustable gastric banding. Such a complication could be severe, and lesions may have unexpected extension requiring complex surgical approach.