Mansour Subhi, Borzellino Giuseppe, Kluger Yoram, Khuri Safi
General Surgery Department, Rambam Health Care Campus, Haifa, Israel.
General Surgery Department, University of Hospital Verona, Verona, Italy.
Int J Surg Case Rep. 2020;77:412-417. doi: 10.1016/j.ijscr.2020.11.023. Epub 2020 Nov 7.
Band migration is a late complication of Laparoscopic Adjustable Gastric Banding insertion, although rare it could be life threatening presenting as peritonitis secondary to gastro-intestinal tract injuries. A case of an unexpected extension of severe gastro-intestinal tract injuries secondary to intra-gastric migration and distal band dislocation is reported.
A 53 years old male, with a history of laparoscopic gastric banding 15 years before and known erosion of the band into the gastric lumen was admitted for abdominal pain and raised serum amylase. Imaging revealed dislocation of the band down to the jejunum. Endoscopy and exploratory surgery showed severe decubitus pressure on the gastric antrum up to the duodenum as well as on the pancreas due to rod-like effect of the gastric band catheter and multiple sites of perforation on distal duodenum and small bowel proximal to the band, which migrated within the lumen until 90 cm distal to the Treitz ligament. Extended distal gastrectomy and resection of distal duodenum and small bowel extended to the proximal affected small bowel were necessary. Digestive tract was restored by a gastro-jejunostomy and duodeno-jejunostomy in a Roux-En-Y configuration with duodenal stump closure on tube duodenostomy. A post-operative leakage from the duodenal stump was treated conservatively and the patient was discharged on post-operative day 21.
Erosion and migration of the band within the digestive lumen is one of the less frequent late complications occurring after LAGB, furthermore, the amount of extensive damage reported in this case presentation has yet to be reported in literature.
Migration of the band should be considered in the differential diagnosis of abdominal complain in patients with adjustable gastric banding. Such a complication could be severe, and lesions may have unexpected extension requiring complex surgical approach.
束带移位是腹腔镜可调节胃束带置入术后的一种晚期并发症，虽然罕见，但可能危及生命，表现为继发于胃肠道损伤的腹膜炎。本文报告一例因胃内移位和束带远端脱位导致严重胃肠道损伤意外扩展的病例。
一名53岁男性，15年前有腹腔镜胃束带置入史，已知束带已侵蚀至胃腔，因腹痛和血清淀粉酶升高入院。影像学检查显示束带移位至空肠。内镜检查和探查手术显示，由于胃束带导管的杆状作用，胃窦直至十二指肠以及胰腺受到严重的褥疮性压迫，束带远端十二指肠和小肠近端有多处穿孔，束带在腔内移位至屈氏韧带远端90 cm处。需要进行扩大的远端胃切除术、远端十二指肠切除术以及将小肠切除至近端受累小肠。通过胃空肠吻合术和十二指肠空肠吻合术以Roux-en-Y构型重建消化道，并通过十二指肠造瘘管封闭十二指肠残端。十二指肠残端术后漏液经保守治疗，患者于术后第21天出院。
束带在消化腔内的侵蚀和移位是腹腔镜可调节胃束带术后较少见的晚期并发症之一，此外，本病例报告中所报道的广泛损伤程度在文献中尚未见报道。
对于接受可调节胃束带手术的患者，腹部不适的鉴别诊断应考虑束带移位。这种并发症可能很严重，病变可能有意外的扩展，需要复杂的手术方法。
