Type:
Educational Exhibit
Keywords:
Volvulus, Acute, Surgery, Barium meal, MR, CT, Anatomy, Abdomen, Ischaemia / Infarction, Stomach (incl. Oesophagus)
Authors:
A. C. O'Brien, C. E. O'Brien, J. Duignan, H. Heneghan, J. McCann; Dublin/IE
DOI:
10.1594/ecr2018/C-0548
Findings and procedure details
St.
Vincent's University Hospital is a tertiary referral centre for bariatric surgery in Ireland.
We have compiled a pictorial review of a number of recent interesting cases that have been performed here.
Complications after Roux-en-Y gastric bypass include:
1.
Bowel ischemia
2.
Small bowel obstruction
3.
Internal herniation
Early complications:
Anastomotic leak
GI bleed
Stomal ulceration
Early stricture
Late complications:
Internal hernia
Stomal ulceration
Stomal necrosis
Gastro-gastric fistula
In the case of expected internal herniation:
- The management is as per bowel obstruction.
- Insert NG tube
- Keep nil by mouth
- IV fluids
- CT abdomen and pelvis
- Refer to bariatric service
High suspicion in young patient with pain out of proportion to exam
Complications after gastric banding include:
1. Malpositioned bands
2.
Band slippage
Early complications:
Dysphagia
GORD
Band slip
Band/tubing fracture
Oedema/stenosis at band site
Late complications:
Band slip
Band erosion
Port malposition/infection/skin necrosis
Over-inflation
Band/tubing fracture
Oesophageal dysmotility
Failure
1-2% get Achalasia-type dysmotility
2/3 of bands are removed within 10 years because of failure or complications
Early morbidity is low,
but gastric bands have the highest long-term risk of any bariatric procedure
Over 50% need reoperation at some stage
In the case of a gastric band slip:
- Dysphagia to liquids,
vomiting,
rarely pain should raise suspicion that there is a problem with the band,
for e.g.
erosion.
- If symptoms don’t settle after deflation admit patient and refer for urgent surgical work-up and probable band removal on same admission.
- However if they get good relief from deflation and are tolerating oral fluids with no pain can discharge home with early follow-up with Bariatric service
- PFA may see slipped band as in previous image
- Bands contain up to 10ml of fluid,
older bands can contain 12ml.
- Patients carry a card with details of the band and how much fuid it is inflated with.
- Take a good history – look for precipitates of band slippage.
E.g.
recent flight.
This can cause auto-fill of band.
- Can also get band unbuckling or leakage of band
Complications after gastric sleeve procedure include:
Early complications:
Staple line leak
GI bleeding (intra/extraluminal)
Vomiting & dehydration
Late complications:
Gastric outlet obstruction
Gallstones
Severe GORD (2%)
17% will get de novo non dysplastic barretts
GORD occurs in 1 in 50 patients.