Massive Upper Gastrointestinal Hemorrhage: An Unusual Presentation After Laparoscopic Adjustable Gastric Banding due to Erosion into the Celiac Axis

Iqbal, Mohd; Manjunath, Srikantaiah; Seenath, Marlon; Khan, Amir

doi:10.1007/s11695-007-9359-9

Cited by 23 publications

(10 citation statements)

References 5 publications

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“…However, in a patient with an acute or serious bleed, especially in the setting of hypotension, such a technique may not reveal the site of bleeding [10]. Diagnosis of a celiac axis erosion in a 49-year-old female with LAGB could not be made via endoscopy alone; an urgent laparotomy finally revealed the location of erosion [11]. In patients presenting with other symptoms such as abdominal pain and port site infections, CT scans and upper GI series provided the means of diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…CT has the added benefit of having the ability to evaluate the erosion of tubing into other structures within the peritoneum and to assess for pneumoperitoneum or asymptomatic intraabdominal abcess [5,8]. Screening patients with CT and upper GI series after lap band surgery has the potential to prevent the development of full-fledged erosion, as chronic band migration and abscesses may be asymptomatic [8,11].…”

Section: Discussionmentioning

confidence: 99%

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Hematemesis From a Left Gastric Artery Pseudoaneurysm Secondary to an Adjustable Laparoscopic Gastric Band

Downes

2014

J Curr Surg

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Gastric band erosion into the lumen of the stomach or the esophagus is a fairly common but often underreported complication of laparoscopic adjustable gastric banding surgery. It occurs in as many as 3-11% of patients who undergo the procedure. We present here the case of a 56-year-old morbidly obese female who developed the sudden onset of hematemesis and dysphagia more than 3 years after laparoscopic gastric band placement. Endoscopy was performed at presentation and revealed erosion into the proximal gastric lumen. The patient was stabilized with medical management of her anemia and abdominal pain. Both the band and subcutaneous reservoir were subsequently removed laparoscopically. A perforation of the gastric wall was identified and treated with a falciform ligament patch and naso-gastric decompression. Five days after surgical band removal, the patient had an episode of hematemesis productive of over 750 cc of blood, accompanied by tachycardia and hypotension. Mesenteric (celiac artery) angiography revealed an actively bleeding pseudoaneurysm of the left gastric artery that was successfully thrombosed with coils. The patient was kept nil per os (NPO) on total parenteral nutrition (TPN) for 1 week postoperatively and remained stable. A follow-up gastrograffin upper gastrointestinal (GI) study showed no leak from the perforation site. To our knowledge, this is the first reported case in which an erosion from an adjustable laparoscopic gastric band was associated with massive upper GI bleeding from a left gastric artery pseudoaneurysm. The case demonstrates the importance of monitoring a patient with hematemesis post lap band surgery, as life-threatening bleeding may persist after removal of the gastric band.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Hematemesis From a Left Gastric Artery Pseudoaneurysm Secondary to an Adjustable Laparoscopic Gastric Band

Downes

2014

J Curr Surg

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“…A lifethreatening event was rarely observed [22,23]. Hypovolemic shock with massive upper gastrointestinal hemorrhage due to erosion into the celiac axis or in the left gastric artery has been reported, as well as small bowel obstruction due to intragastric band erosion [24][25][26]. In most cases, clinical symptoms are absent or mild and transient, and many authors agree that a pathognomonic manifestation of intragastric erosion is absent [1][2][3][4][5][6]14].…”

Section: Discussionmentioning

confidence: 99%

Intragastric gastric band migration: erosion: an analysis of multicenter experience on 177 patients

Lorenzo

Furbetta

et al. 2012

Surg Endosc

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Background Laparoscopic adjustable gastric banding (LAGB) has proven to be a safe and effective surgical treatment for morbid obesity. It can be a simple, fast, reversible, anatomy-preserving procedure. Despite these advantages, its long-term efficacy came into question by the occurrence of complications such as intragastric band migration. Consistent information regarding this complication is still lacking. Treatment for migration is still being debated as well. Most of the inconsistencies of these data stem from the very low number of patients reported in single-center experiences or case reports. Lack of multicenter experience is evident. The aim of this study was to perform a retrospective analysis of data on intragastric migration in a large multicenter cohort of patients who underwent LAGB. Methods A retrospective multicenter study on LAGB patients was performed. Data had been entered into a prospective database of the Italian Group for LapBand Ò (GILB) since January 1997. Pars flaccida and perigastric positioning were considered along with different kinds of gastric bands by the same manufacturer. Time of diagnosis, mean body mass index (BMI), presentation symptoms, and conservative and surgical therapy of intragastric migration were considered. Results From January 1997 to December 2009, a total of 6,839 patients underwent LAGB and their data were recorded [5,660 females, 1,179 males; mean age 38.5 ± 18.2 years (range 21-62 years); mean BMI = 46.7 ± 7.7 kg/m 2 (range 37.3-68.3); excess weight (EW) 61.8 ± 25.4 kg (range 36-130); %EW 91.1 ± 32.4 % (range 21-112 %)]. A total of 177 of 6,839 (2.5 %) intragastric erosions were observed. According to the postoperative time of followup, the diagnosis of intragastric migration was made in 74 (41.8 %), 14 (7.9 %), 38 (21.4 %), 40 (22.6 %), 6 (3.4 %), and 4 (2.2 %) banded patients at 6-12, 24, 36, 48, 60, and 72 months after banding, respectively. Most of intragastric band migration during the first 2 years occurred in bands with no or a few milliliters of filling. In patients with late erosion, the bands were adjusted several times; no band was overfilled but one was filled to the maximum or submaximum with a maximum of two adjustments. Erosions diagnosed during the first 24 months were related to the experience of the surgical staff, while late erosions were not. Conclusions Intragastric band migration or band erosion is a rare, disturbing, and usually not life-threatening complication of gastric banding. Its pathogenesis is probably linked to different mechanisms in early (technical failure in retrogastric passage) or late (band management) presentation. It is usually asymptomatic and there is no pathognomonic presentation. A wide range of therapeutic options are available, from simple endoscopic or laparoscopic removal to early or late band replacement or other bariatric procedure. More experience and more studies are needed to lower its presentation rate and definitively clarify its pathogenesis to address the right therapeutic option.

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“…6 Although most erosions occur where the gastric wall is in contact with the band, erosion of the connection tubing into the intestine and neighboring structures, such as the colon, celiac axis, and renal hilum, is a much rarer, yet reported complication. [13][14][15][16][17][18][19] Most authors report a median time of 12-24 months from band placement to erosion, but it may occur more than 10 years after LAGB placement. 20,21 Because the erosion tends to develop gradually over time, 21 most cases are nonurgent.…”

Section: Erosion Of Gastricmentioning

confidence: 99%

Erosion of Gastric Band Tubing Presenting as Port-Site Cellulitis

Felinski

Bajwa

Shah

2017

CRSLS

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Massive Upper Gastrointestinal Hemorrhage: An Unusual Presentation After Laparoscopic Adjustable Gastric Banding due to Erosion into the Celiac Axis

Cited by 23 publications

References 5 publications

Hematemesis From a Left Gastric Artery Pseudoaneurysm Secondary to an Adjustable Laparoscopic Gastric Band

Hematemesis From a Left Gastric Artery Pseudoaneurysm Secondary to an Adjustable Laparoscopic Gastric Band

Intragastric gastric band migration: erosion: an analysis of multicenter experience on 177 patients

Erosion of Gastric Band Tubing Presenting as Port-Site Cellulitis

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