Bolus obstruction of pouch outlet by a granular bulk laxative after gastric banding.
BACKGROUND
Constipation is an occasional problem after gastric banding and is often caused by insufficient liquid intake. As a result, the use of laxatives is widespread in such patients. Depending on the laxative, improper use can lead to bolus obstruction above the band, as occurred in this case.


METHODS
A 59-year-old female with uncomplicated laparoscopic adjustable gastric banding presented 2 months after surgery with food and liquid intolerance and dysphagia after ingestion of a granular bulking laxative. Despite deflating the band, the bolus could not be washed out. Endoscopic extraction was required, revealing a 4x2 cm bolus of the laxative and a small compression ulcer.


CONCLUSIONS
Patients not complying with nutritional recommendations after gastric banding may have insufficient liquid intake and, consequently, constipation. Under these conditions, the use of a granular bulking laxative entails the risk of esophageal obstruction above the band.


CONCLUSIONS
Nutritional counseling after gastric banding should include the recommendation of liquid intake of at least 1.5 l/day. If constipation occurs, osmotic or paraffin oil laxatives should be used instead of bulking laxatives.
Department of Surgery, St. Claraspital, Basel, Switzerland.
Florian
F
Herrle
Thomas
T
Peters
Claudio
C
Lang
Markus
M
von Fluee
Beatrice
B
Kern
Ralph
R
Peterli
D001630:Bezoars / Q000175:diagnosis / Q000209:etiology*; D002400:Cathartics / Q000009:adverse effects*; D003248:Constipation / Q000188:drug therapy / Q000209:etiology; D003680:Deglutition Disorders / Q000209:etiology; D004338:Drug Combinations; D004947:Esophagus; D005260:Female; D015391:Gastroplasty; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D010936:Plant Extracts / Q000009:adverse effects*; D010943:Plantago; D011183:Postoperative Complications; D012676:Senna Extract / Q000009:adverse effects*
D002400:Cathartics; D004338:Drug Combinations; D010936:Plant Extracts; C024255:ispaghula, senna drug combination; D012676:Senna Extract