Images in Surgery| Volume 172, ISSUE 4, e37-e38, October 2022

Small bowel obstruction after laparoscopic adjustable gastric band: The gastric band is not always the one involved

Published:April 29, 2022DOI:
      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 thumbnail gr1
      Figure 1Abdominal CT scan, portal injection: loop of the connecting tube around the mesenteric vessels (white arrow).
      Figure thumbnail gr2
      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.
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