title: LAP-banding obesity: a case of stomach perforation, peritonitis, and death.
abstract: We present a case of peritonitis and death due to the misplacement of a laparoscopic adjustable band inserted through, instead of around, the stomach. This represents the first case in the published literature where a LAP-BAND perforated the stomach, followed by peritonitis and death. The morbidly obese female patient with a history of hypertension and arthritis was 47 years old, 5 feet 6 inches tall, weighed 361 pounds, and had a body mass index of 58.3. She underwent a 2-hour, elective, LAP-band insertion operation to achieve weight loss; 27 hours after band insertion, following the conduction of all FDA-mandated Lap-Band postoperative protocol (including a radiologic Gastrogrografin swallow), the patient was discharged with "no evidence of esophageal stasis or obstruction." She remained out of hospital care and in her residence until she called for and was taken by an ambulance to an alternate, local hospital (57 hours after band insertion), when gastric perforation was confirmed via x-ray and CT scans. No open surgery was attempted to repair the damage, and cardiac arrest ensued 7 hours after admission to the second hospital. The patient was pronounced dead 64 hours after LAP-band insertion. This unique case is significant, given that there were no deaths of this kind reported in The LAP-BAND(R) Adjustable Gastric Banding System Summary of Safety and Effectiveness Data by the United States Center for Devices and Radiologic Health, of the Food and Drug Administration, or in searches of the published literature.
authors.affiliation: Office of the Wayne County Medical Examiner, Detroit, Michigan 48207, USA. cloewe@co.wayne.mi.us
authors.forename: Cheryl
authors.initials: C
authors.lastname: Loewe
authors.forename: Francisco
authors.initials: F
authors.lastname: Diaz
authors.forename: Andrea
authors.initials: A
authors.lastname: Jackson
mesh_terms: D005260:Female; D049429:Forensic Pathology; D015391:Gastroplasty / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D010538:Peritonitis / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D013272:Stomach Diseases / Q000209:etiology / Q000401:mortality* / Q000473:pathology