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A 67-year-old woman with a history of laparoscopic adjustable gastric banding 15 years
ago was admitted with abdominal pain associated with nausea, vomiting, and respiratory
distress. The patient’s comorbidities were psychiatric disease and eventration’s repairs.
The patient was hemodynamically unstable with a heart rate of 125 bpm and mean arterial
pressure of 80 mm Hg. Physical investigation revealed diffuse abdominal pain associated
with an abdominal guarding, a distended abdomen, and absent bowel sounds. Laboratory
tests revealed an increase in C-reactive protein and leukocytosis, acidosis, hyponatremia,
and acute renal failure. A CT scan without injection revealed a small bowel obstruction
(SBO) in the right lower quadrant with ischemic signs (mesenteric infiltration, walls’
thickening) (Figure 1, A). A surgery was required via a midline laparotomy because of the patient’s clinical
deterioration and the high suspicion of small bowel ischemia (Figure 2).
Figure 1Abdominal CT scan, portal injection: loop of the connecting tube around the mesenteric
vessels (white arrow).
Figure 2Per-operative view: the laparotomy exploration found a strangulation of the small
bowel by the connecting tube (white arrow) with an area of ischemia.
