45 yo female presented with abdominal pain and multiple vomiting

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1010 Endo Poster
SMALL BOWEL OBSTRUCTION CAUSED BY THE TUBING
SYSTEM AFTER LAGB
Ronit Grinbaum, Nurith Hiller *, Haggi Mazeh, Herbert R. Freund,
Mahmud Baddariah, Nahum Beglaibter
Department of Surgery and Radiology*, Hadassah University Hospital,
Mount Scopus Jerusalem
Introduction: we recently encountered a rare and to the best of our
knowledge non-reported complication of small bowel obstruction caused by
the tubing system of a Laparoscopic Band (LAGB).
Case report: A 45 year-old female patient was admitted with abdominal
pain and vomiting which began on the day of admission. Past history
included SRVG in 1998, laparoscopic cholecystectomy in 1999 followed by
appendectomy and hysterectomy. Due to recurrent vomiting, dysphagia and
total food intolerance she underwent gastro-gastrostomy and adjustable
gastric band placement in 2000. Physical examination on admission was
remarkable for soft, slightly distended abdomen with epigastric tenderness,
no peritoneal signs. Abdominal plain film showed distended small bowel
loops with air fluid levels. An UGI series showed the band in normal
position with no sign of obstruction at the level of the band. Abdominal CT
demonstrated small bowel obstruction with looping of the band tube around
a jejunal loop with consequent obstruction. At laparoscopic exploration,
multiple adhesions were encountered but the obstruction was clearly caused
by the tube which crossed the meso of the trapped loop forming a tight
chronic stricture. The tubing was cut to release the obstruction and a mini
laparotomy was done to repair the tubing and replace the access port. The
patient did well and was discharged on post operative day 3.
Conclusion: intestinal obstruction due to the tubing system is one more
cause to be considered in the differential diagnosis of intestinal obstruction
in patients who underwent LAGB.