Abdominal Catastrophe During Pregnancy Due to a Gastric Band

Gurdeep S. Matharoo, MD, Samir R. Shah, MD, Steven J. Binenbaum, MD, Frank J. Borao, MD

Department of Surgery, Monmouth Medical Center, Long Branch, NJ, USA (all authors).

ABSTRACT

Introduction: Laparoscopic adjustable gastric banding is popular bariatric procedure for patients with morbid obesity. The procedure is appealing to patients and surgeons because of its customizable approach to weight loss. The rate of complications after laparoscopic adjustable gastric banding has been reported to be up to 12.2%. Without a high degree of suspicion, the complications can go unrecognized until they have progressed to a catastrophic state.

Case Description: We present a 32-year-old pregnant woman, with a history of laparoscopic adjustable gastric banding, who presented with complaints of persistent nausea and vomiting causing significant weight loss. She was treated with intravenous hydration and antiemetic medication. After 3 days of in-hospital treatment, she was discharged home after resolution of symptoms. She then returned to the hospital with severe abdominal pain. The fetal heart tones were lost, and she delivered a stillborn fetus. Radiologic testing suggested abdominal hollow organ perforation, and the patient was taken to the operating room. Diagnostic laparoscopy discovered a prolapsed gastric band causing obstruction and an anterior gastric perforation proximal to the band. The perforation was repaired primarily, and an omental patch was used as a buttress.

Conclusion: Although nausea and vomiting are common symptoms during pregnancy, their cause must be fully investigated in bariatric patients. The complications in bariatric patients can be catastrophic if not recognized and treated appropriately. As weight loss surgery increases in popularity and age limits are decreased, more women of childbearing age will present after bariatric procedures, and all complications must be ruled out.

Key Words: Laparoscopic adjustable gastric banding, LAGB, Pregnancy, Bariatric surgery, Hyperemesis gravidarum, Abdominal catastrophe.

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