Michael C Morell, MD, Matthew D Whealon. University of California, Irvine
This video submission is a case report of an exceedingly uncommon complication after lap band surgery.
The patient is a 65 year old woman with a history of lap band surgery who was transferred to UCI with a diagnosis of both a slipped lap band and pulmonary embolus noted on CT imaging. Her presenting complaints were of chest pain and shortness of breath. Further work up included an upper GI which revealed a mildly prominent gastric pouch with no evidence of leak or perforation. After experiencing atrial fibrillation that failed medical conversion an echocardiogram was performed which revealed a large pericardial fluid collection and possible impending cardiac tamponade. These findings were additionally supported with CT imaging. Due to these findings, in spite of a completely benign clinical exam, a pericardial drain was placed. EGD was performed which revealed an almost completely eroded lap band. Due to these findings the patient was taken to surgery for lap band removal.
In the operating room the device appeared buried within omental fat. Due to the fact that the device buckle was not seen intraluminally on EGD, endoscopic retrieval or lateral gastrotomy and luminal extraction would prove difficult. The band was removed from an anterior approach during which time a large gastrotomy was encountered. The band was removed and a conservative non-radical repair was performed with a modified omental patch reinforced with fibrin sealant.
The patient progressed well postoperatively. Nasogastric tube, pericardial drains and JP drains were removed as the patient's diet was advanced. Post operative imaging including CT, upper GI and echocardiogram continue to show a small persistent gastropericardial fistula, but no intraabdominal extravisation of contrast.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80768
Program Number: V160
Presentation Session: Case Presentations
Presentation Type: Video
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