Gastric emphysema secondary to laparoscopic gastric band erosion

Abstract

INTRODUCTIONGastric band erosion is a known complication of adjustable gastric band surgery. There are no previous reports of gastric band erosion associated with gastric emphysema (GE) or emphysematous gastritis (EG), a rare condition with a mortality rate exceeding 50%.PRESENTATION OF CASEWe report the first known case of GE found in a 58-year-old lady presenting with acute onset epigastric abdominal pain and haematemesis in the setting of a chronically eroded gastric band. GE was visualised in the anterior gastric wall of the stomach without evidence of EG. Endoscopic and surgical examination of the stomach was undertaken along with band removal followed by defect repair.DISCUSSIONGE can result from obstructive, traumatic and pulmonary causes. EG is a rare and often lethal form of GE resulting from bacterial invasion of the gastric wall through a mucosal defect leading to sepsis and gastric necrosis. Early reports documented early definitive operative debridement of necrotic gastric wall of patients with EG while recent reports have demonstrated a feasible non-operative approach among highly selected patients with no evidence of gastric necrosis. There are no previous reports on the treatment of patients with gastric band erosion and suspected EG.CONCLUSIONPatients presenting acutely with symptomatic gastric band erosion, radiological evidence of GE with evidence of leucocytosis, peritonism or sepsis may develop EG. A high index of suspicion, low threshold for operative exploration and optimal management with antimicrobial therapy and close supportive care are necessary to ensure the best survival outcomes for these patients.

Late-Onset Gastric Band Erosion Following Heavy Nonsteroidal Anti-inflammatory Drug Use

“…6,17 There is even reported gastric emphysema stemming from an eroded LAGB, which carries a high mortality risk. 7 At present, there are limited guidelines on post-LAGB placement surveillance in asymptomatic patients. In 2020, the International Federation for the Surgery of Obesity and Metabolic Disorders recommended upper endoscopy on the basis of symptoms.…”

“…[4][5][6] Case reports highlight the dangers of LAGB erosion, including gastric emphysema or distal migration which can, respectively, lead to emphysematous gastritis or obstruction with perforation. 6,7 Therefore, identification of risk factors toward LAGB erosion is critical. We report a case of near-complete intraluminal LAGB erosion, 13 years after initial placement and in the setting of heavy nonsteroidal anti-inflammatory drug (NSAID) use.…”

Gastric emphysema secondary to severe vomiting: a comparative review of 14 cases

“…Air in other portions of bowel is usually not present but hepatic portal venous gas can be observed concurrently with gastric emphysema. Unlike gastric emphysema, emphysematous gastritis appears as a streaky distribution of air with gastric wall thickening along with air in the other bowel segments, and it is notable that pneumobilia and hepatic portal venous gas have more commonly been encountered in these patients 9. However, it is important to understand that these radiological differences may still not be adequate and they should not be solely relied on while making a treatment decision.…”