title: Gastric emphysema secondary to laparoscopic gastric band erosion.
abstract: BACKGROUND
  Gastric band erosion is a known complication of adjustable gastric band surgery. There are no previous reports of gastric band erosion associated with gastric emphysema (GE) or emphysematous gastritis (EG), a rare condition with a mortality rate exceeding 50%.
  
  
  METHODS
  We report the first known case of GE found in a 58-year-old lady presenting with acute onset epigastric abdominal pain and haematemesis in the setting of a chronically eroded gastric band. GE was visualised in the anterior gastric wall of the stomach without evidence of EG. Endoscopic and surgical examination of the stomach was undertaken along with band removal followed by defect repair.
  
  
  CONCLUSIONS
  GE can result from obstructive, traumatic and pulmonary causes. EG is a rare and often lethal form of GE resulting from bacterial invasion of the gastric wall through a mucosal defect leading to sepsis and gastric necrosis. Early reports documented early definitive operative debridement of necrotic gastric wall of patients with EG while recent reports have demonstrated a feasible non-operative approach among highly selected patients with no evidence of gastric necrosis. There are no previous reports on the treatment of patients with gastric band erosion and suspected EG.
  
  
  CONCLUSIONS
  Patients presenting acutely with symptomatic gastric band erosion, radiological evidence of GE with evidence of leucocytosis, peritonism or sepsis may develop EG. A high index of suspicion, low threshold for operative exploration and optimal management with antimicrobial therapy and close supportive care are necessary to ensure the best survival outcomes for these patients.
authors.affiliation: Gosford Hospital, Gosford, Australia. Electronic address: michael.zy.su@gmail.com.
authors.forename: Michael Z
authors.initials: MZ
authors.lastname: Su
authors.affiliation: Gosford Hospital, Gosford, Australia.
authors.forename: William S
authors.initials: WS
authors.lastname: Munro
keywords: Bariatric surgery; Emphysematous gastritis; Gastric band; Gastric emphysema; General surgery