Calmes J M, Bettschart V, Raffoul W, Suter M
Department of Surgery, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland.
Obes Surg. 2002 Oct;12(5):699-702. doi: 10.1381/096089202321019729.
Band infection after gastric banding is a relatively rare complication. In most cases, it is manifested by abdominal pain associated with fever, and/or an abscess surrounding the access port. The treatment of choice consists of band removal and antibiotic therapy, and is usually effective.
Among the 322 patients having undergone gastric banding in our department, we report a 31-year-old woman who developed an infection of the band complicated by splenic and portal vein thrombosis 21 months after gastric banding.
BMI was 40.9 kg/m2 when she underwent gastric banding. Postoperative course was uneventful, and excess weight loss reached 105% after 18 months. An abdominoplasty combined with bilateral mammoplasty and thigh dermolipectomy were performed. About 3 weeks later, she developed an otitis with fever and left upper abdominal pain. Despite antibiotics, pain and fever persisted. The operative wounds showed no sign of infection, and there was no sign of peritonitis. Computerized tomography showed a left subdiaphragmatic abscess surrounding the catheter and thrombosis of the splenic and portal veins. Treatment consisted of band removal, antibiotics and heparin. Recovery was uneventful with complete resolution of the thrombosis.
Late band infection after gastric banding is rare, and is usually secondary to band erosion. Our case demonstrates that severe band infection can be caused by any infection causing bacteremia. Prompt band removal along with antibiotic therapy is the treatment of choice. Rapid treatment of any infection is mandatory in patients with a gastric band. Antibiotic prophylaxis during surgical and dental procedures could be useful in these patients.
胃束带术后束带感染是一种相对罕见的并发症。在大多数情况下，其表现为伴有发热的腹痛和/或围绕接入端口的脓肿。治疗选择包括移除束带和抗生素治疗，通常有效。
在我们科室接受胃束带手术的322例患者中，我们报告了一名31岁女性，她在胃束带术后21个月发生了束带感染，并并发脾静脉和门静脉血栓形成。
她接受胃束带手术时的体重指数为40.9kg/m²。术后过程顺利，18个月后体重减轻超过105%。她接受了腹部整形术联合双侧乳房整形术和大腿皮肤切除术。大约3周后，她出现了发热伴左耳炎和左上腹疼痛。尽管使用了抗生素，疼痛和发热仍持续存在。手术伤口没有感染迹象，也没有腹膜炎迹象。计算机断层扫描显示左膈下脓肿围绕导管，脾静脉和门静脉血栓形成。治疗包括移除束带、使用抗生素和肝素。恢复顺利，血栓完全溶解。
胃束带术后晚期束带感染罕见，通常继发于束带侵蚀。我们的病例表明，任何导致菌血症的感染都可引起严重的束带感染。及时移除束带并联合抗生素治疗是首选治疗方法。对于佩戴胃束带的患者，必须迅速治疗任何感染。在手术和牙科手术期间进行抗生素预防可能对这些患者有用。
