laparoscopic adjustable gastric banding ( lagb ) is a restrictive bariatric technique used in the management of morbid obesity , defined as a body mass index ( bmi ) of more than 45 kg / m . today , it is a popular choice in managing morbid obesity surgically due to its lower complication rates and technical simplicity and safety , when compared to other bariatric surgical procedures.(1 ) lagb was proven to result in a more significant reduction in weight ; in addition to significantly improving obesity - related co - morbidities such as type-2 diabetes mellitus , hypertension , and dyslipidemia ( 2 ) . its proven role in preventing obesity - related obstetric complications add to its favourability(3 ) . regarding the causes of mortality in lagb , pulmonary embolism yields the highest mortality rates in the early post - operative period ( 4 ) . on literature review , only two cases of mortality in the early post - operative period were due to stomach necrosis as a complication of lagb(5 ) . to our knowledge , this is the first reported case of stomach torsion in pregnancy as a complication of lagb . we present a 25-year - old primigravida in her 29 weeks of gestation , with a two - week history of persistent vomiting associated with upper abdominal pain . past surgical history included a previous laparoscopic cholecystectomy and lagb in 2007 , which was deflated once the pregnancy was discovered . on physical examination , abdominal examination was unremarkable apart from a palpable uterus , which conformed to the gestational age . blood results showed a reduced serum albumin at 32g / dl , with normal full blood count , urea and electrolytes , and liver function . ultra sound - abdomen and oesophogastroduodenoscopy ( ogd ) x - ray studies and computed tomography ( ct ) were contraindications due to pregnancy . initially , we commenced conservative management with antiemetic , antispasmodic , analgesia , and proton pump inhibitor . we sought advice from the bariatric surgery team who agreed with our conservative management and close observation . the patient 's oral intake was deteriorating , therefore feeding via nasogastric tube ( ngt ) was commenced in order to maintain the patient 's nutritional status ; and was later replaced with peripheral total parenteral nutrition ( tpn ) due to the patient 's intolerance to the ngt . the patient 's condition failed to improve after being managed conservatively for two weeks , and her nutritional status continued to deteriorate . this eventually led to the development of fatty liver , manifested as a raised alanine aminotransferase ( alt ) of 591 and fatty liver changes on abdominal ultrasound . the fetus was also affected adversely as evident by an intra uterine growth restriction ( iugr ) shown on obstetric growth ultra sound scan . in response to this deterioration , a multidisciplinary decision was made to proceed to an elective caesarean section at 32 weeks , three weeks after admission . outcome of the caesarean section was a male , weighing 1875 g , who was admitted to the neonatology unit due to prematurity . during the post - partum period , the liver function , namely alt , was noted to improve to normal levels . a barium swallow study , performed on the fifth day post - operation was reported , initially by a senior radiologist , as not showing evidence of mechanical obstruction . however , due to the patient 's continued deterioration , we suspected mechanical obstruction after reviewing the barium swallow , so we sought a second opinion from the radiology department , who confirmed this ( figure 1 ) . therefore , a decision to proceed with an urgent laparotomy that was performed that afternoon . barium swallow showing signs of mechanical obstruction with no contrast seen beyond the fundus of the stomach . the arrow demonstrates the gastric band , which was found behind the stomach acting as an axis for gastric torsion intra - operatively , the gastric band was found in adhesion posterior to the stomach , and was removed . the stomach , which was found torted at 180 degrees , remained viable and was therefore not resected . the patient continued to improve and was shortly discharged . on her four months outpatient follow - up , the patient was well , asymptomatic and gained one stone in weight . in the case of our patient , we believe that the vomiting in addition to the vertical growth of the uterus led to a gradual rotation of the stomach antero - ventrally . the fact that the gastric band was fixed ( secondary to adhesions ) to its surrounding structures including the posterior aspect of the stomach , suggests that the gastric band acted as an axis or pivot onto which the stomach rotated in the manner described previously , eventually resulting in torsion of the stomach . the delay in reaching the diagnosis in this case equated to a delay in commencing definitive treatment , and as a result , the patient developed fatty liver and fetal intrauterine growth restriction . this is due to the fact that it was challenging to treat our patient , as her symptoms were indeed non - specific and quite common in pregnancy . in addition , we had a limited number of imaging studies available for use during pregnancy . this case also highlights the difficulty in managing the complications of lagb in small district general hospitals , as the staffs are not exposed regularly to the complications of lagb .
laparoscopic adjustable gastric banding ( lagb ) was done for the first time in belgium in 1993 . 
 gastric torsion after band slippage is extremely rare . 
 literature review of gastric banding and complications in pregnancy did not reveal any case of gastric torsion . 
 hence , we report this rare case of gastric torsion in a pregnant lady following gastric banding .