Phytobezoar After Laparoscopic Gastric Band Procedure Following Pregnancy and Consumption of Vegetable Matter

Anthony Galitsky, MD, Dmitry Nepomnayshy, MD, Elizabeth M Prusak, MD, Lellan Sillin, MD, David M Brams, MD, David L Burns, MD, Pamela J O’Brien, ANPBC. Lahey Clinic

Phytobezoars after a laparoscopic gastric band procedure (LAGB) have been rarely described with only six cases appearing in the literature and none following pregnancy. We present a case report of a 37 year old female 4 weeks postpartum, who was also 3.5 years after having a laparoscopic adjustable gastric band. She complained of a 10 day history of a total inability to swallow any solid foods, and some difficulty tolerating liquids. Upper GI study revealed a tight appearing band with decreased flow through the lumen despite the band being emptied. A CT scan showed a possible food impaction above a normal appearing band with a dilated proximal pouch. The EGD showed a phytobezoar in the pouch above the band. The bezoar was broken up with the gastroscope and pushed through the lap band into the stomach. The patient tolerated the procedure and her symptoms of dysphagia, nausea and vomiting completely resolved. Upon further questioning she admitted to consuming some coconut 10 days prior to presentation. Although trichobezoars (containing hair) are considered the most common type of bezoars associated with pregnancy, this article is the first to describe effect of pregnancy on the formation of phytobezoars following a LAGB procedure. High progesterone levels associated with pregnancy have been shown to impair gastric emptying. The type of bezoar and the additive effect of pregnancy and having a LAGB is an area for discussion. Management options for LAGB during pregnancy such as routine band deflation or change in diet may be considered


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Program Number: P026
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