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Plain abdominal X-ray showing gastric band localized to the left lower quadrant (arrow).
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Revision of a plain abdominal X-ray done several months prior (former admittance due to biliary pancreatitis) demonstrated gastric band localized in the left lower quadrant of the abdomen, and therefore, distal migration was suspected (Fig. 1).
On Coronal abdomino-pelvic CT scan, the gastric band is localized in the upper jejunum (long arrow), with the catheter (short arrow) passing through the upper gastrointestinal tract. Thickened small bowel wall, as well as surrounding fat haziness is also seen.
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Tomography (CT) scan was obtained, which showed a port located subcutaneously at the upper abdominal wall, attached to the catheter which enters the stomach and passes through the duodenum distally to the upper part of the jejunum, where the gastric band was located (Fig. 2). The wall of the small bowel surrounding the catheter and the band was thickened with haziness of the nearby fatty tissues.
Intra-operative upper Endoscopy demonstrating severe decubitus pressure changes involving the gastric antrum and duodenum due to rod like effect of the gastric band catheter.
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These changes were the result of a rod-like effect of the band catheter, being fixed at the proximal (port) and distal (band) sides (Fig. 3).
On exploration of the abdomen, multiple perforation sites of different diameter were demonstrated along the upper jejunum.
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In addition, 9 perforation sites along the first 90 cm of the jejunum were noticed (Fig. 4).
Figure 5 demonstrates severe pressure effect involving the posterior and medial wall of the duodenum, following distal gastrectomy.
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The proximal duodenal stump closed primarily following the insertion of duodenostomy tube due to severe pressure effect involving the posterior and medial wall (Fig. 5).
This figure demonstrates the hypothesized journey of the gastric banding in the upper gastrointestinal tract.
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The hypnotised theory for the aforementioned injury is internal penetration and distal migration of the gastric band causing rod-like pressure necrosis of the involved organs (Fig. 6).