Intractable abdominal pain following laparoscopic adjustable gastric banding.
A 42-year-old woman presented with intractable crampy abdominal pain continuing for 1 year. The pain worsened after eating and improved when walking. She had undergone laparoscopic adjustable gastric banding 4 years previously, with re-banding 18 months later because of anterior band slippage. The patient underwent numerous examinations, all with normal findings. A scintigraphy finally showed some tracer enrichment in the terminal ileum, which led to the assumption that a Meckel's diverticulum was causing her discomfort. Subsequent diagnostic laparoscopy showed no Meckel's diverticulum but instead displaced tubing, which was wrapped around the mesenteric root. The mesenteric root showed scarred alterations from chronic strangulation. After replacing the tubing from the band the abdominal pain immediately vanished. In retrospect, the contrast study of the gastric band shows unnatural traction of the tubing towards the lower abdomen, allowing suspicion of the intraoperative findings.
Daetwiler
Silvia
S
Department of Surgery, Limmattalspital, Schlieren, Switzerland. silviedaetwiler@hotmail.com
Adamina
Michel
M
Schöb
Othmar
O
D015746:Abdominal Pain / Q000209:etiology*; D000328:Adult; D005260:Female; D005548:Foreign-Body Migration / Q000150:complications*; D015391:Gastroplasty / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D010535:Laparoscopy; D009767:Obesity, Morbid / Q000601:surgery*; D010148:Intractable Pain / Q000209:etiology*