“Black Esophagus” and Gastric Volvulus Following Slipped Laparoscopic Adjustable Gastric Band

Abstract

To review the entity "black esophagus" and sequela of a slipped laparoscopic adjustable band. The patient's history, physical examination, imaging, and endoscopic findings were reviewed. Detailed review of pathophysiology, presentation, diagnosis, management, and natural history was conducted. "Black esophagus," also known as acute esophageal necrosis (AEN), is a rare condition resulting in black discoloration of the mid to distal esophagus with less than a hundred reported cases. It has not been previously documented in bariatric surgery or following laparoscopic adjustable gastric banding. The volvulus was reduced at surgery, and the esophageal changes resolved without sequela. "Black esophagus" is an acute, ominous-appearing condition with a spectrum ranging from superficial mucosal disease to transmural involvement with perforation. Fortunately, esophageal resection is rarely required.

Diagnosis and management of acute esophageal necrosis

“…One of these conditions that result in transient gastric outlet obstruction is gastric volvulus, which may culminate in AEN. In fact, there are cases of gastric volvulus secondary to large hiatal hernias [19], a slipped laparoscopic adjustable gastric band [85] or gastrostomy tube balloon migration into the duodenum [86], culminating in AEN. Uneventful recovery of esophageal mucosa usually follows correction of gastric volvulus [85].…”

“…This characteristic endoscopic appearance is sufficient to establish the diagnosis. Additional endoscopic findings may include signs of bleeding (active oozing from distal esophagus [106], blood clots [26] and/or “coffee ground” material in the stomach [85], multiple esophageal ulcerations [106], gastric ulcers [37], duodenal pathology (ulcers, erosions or edema) [39], or gastric outlet obstruction due to gastric volvulus [19].…”

Delayed Gastric Twisting After Gastric Band Removal: a Case Report

“…Early diagnosis and treatment are crucial in patients with vomiting after LAGB after band removal as well. The few reports on cases of gastric twisting after band removal prevented the authors from proposing an optimal diagnostic tool; however, abdominal CT scan may help with the early diagnosis of life-threatening complications such as gastric or esophageal ischemia and necrosis and perforation (3,(7)(8)(9)(10). A CT scan similar to the one performed in this report (Figure 1b) can also help make a correct diagnosis.…”

“…The obstruction of the stomach and small intestine caused by the erosion of the gastric band into the gastric cavity and its migration to the distal parts was relieved by band removal (5,6). A closed-loop gastric obstruction caused by volvulus (7) can increase morbidity and mortality as a result of the associated gastric and esophageal necrosis and perforation (7,8). As the third leading cause of gastric twisting, gastric obstruction can occur after removing the gastric band (3,9).…”

Vólvulo gástrico: reporte de caso en el Hospital Central Universitario del Estado de Chihuahua

“…En la forma aguda, la tríada de Borchardt (distensión epigástrica severa con dolor abdominal, arcadas intratables e incapacidad para pasar una SNG) es diagnóstica en 70% de los pacientes adultos. 3,10 El subagudo se caracteriza por malestar abdominal vago, mientras que en el VG crónico su sintomatología es inespecífica con dolor epigástrico, saciedad precoz, náuseas o vómito, 8 otros síntomas pueden ser dolor torácico atípico, anemia, pérdida de peso, disnea, reflujo, distensión abdominal postprandial o disfagia y pueden aparecer de forma irregular durante semanas o años. 7 Se debe enfatizar en la alta probabilidad de agudización del VG crónico.…”