Widmer Jeannette D, Schade Stephanie, Muller Markus K
Department of Surgery, Kantonsspital Frauenfeld, 8500, Frauenfeld, Switzerland.
J Med Case Rep. 2018 Oct 17;12(1):297. doi: 10.1186/s13256-018-1850-5.
Laparoscopic adjustable gastric banding has been the gold standard for surgical management of obesity over the last decades in USA and Europe. However, significant complications have been documented due to foreign body placement, including band erosions. Our treatment approach for erosions is rather observant with regular follow-up until the band has sufficiently perforated the gastric wall which facilitates endoscopic removal. Consequences of a not followed-up band erosion may present even after a long time following initial diagnosis with more severe complications.
A 51-year-old Caucasian woman presented to our out-patients' clinic with a 2-week history of worsening abdominal pain in her left upper quadrant, exacerbated by abdominal flexion and extension maneuvers. Here we describe a case involving gastric penetration and subsequent downward migration of a band into distal jejunum causing small bowel obstruction, which occurred more than 10 years following initial diagnosis of erosion. The perforation was missed due to cessation of endoscopic follow-up.
Prospective and long-term follow-up is mandatory in those with partial band erosion to avoid further complications.
在过去几十年里，腹腔镜可调节胃束带术一直是美国和欧洲肥胖症手术治疗的金标准。然而，由于异物置入已记录到显著并发症，包括束带侵蚀。我们对侵蚀的治疗方法是相当保守的，进行定期随访，直到束带充分穿透胃壁，便于内镜取出。即使在初始诊断后很长时间，未随访的束带侵蚀后果也可能出现更严重的并发症。
一名51岁的白人女性到我们门诊就诊，左上腹腹痛加重2周，腹部屈伸动作会使其加剧。在此，我们描述一例病例，该病例涉及胃穿孔以及随后束带向下迁移至空肠远端导致小肠梗阻，这发生在最初诊断侵蚀后的10多年。由于停止了内镜随访，穿孔未被发现。
对于部分束带侵蚀患者，必须进行前瞻性长期随访以避免进一步并发症。
