Acute gastric obstruction following cardiopulmonary bypass in a patient with an adjustable gastric band
Journal of Cardiothoracic Surgery ,
Dec 2015
Raed Azzam , Abdelrahman Abdelbar , Andrew Brazier , Bilal H Kirmani , Ragheb Hasan
Acute gastric obstruction following cardiopulmonary bypass in a patient with an adjustable gastric band
Azzam et al. Journal of Cardiothoracic Surgery
Acute gastric obstruction following cardiopulmonary bypass in a patient with an adjustable gastric band
Raed Azzam 0 1
Abdelrahman Abdelbar 0 1
Andrew Brazier 0 1
Bilal H Kirmani 0 1
Ragheb Hasan 0 1
0 Department of Cardiothoracic Surgery, Manchester Heart Centre, Manchester Royal Infirmary , Oxford Road, Manchester, M13 9WL , UK
1 From World Society of Cardiothoracic Surgeons 25th Anniversary Congress , Edinburgh Edinburgh, UK. 19-22 September 2015
Background/Introduction
Obesity is a major problem with the number of obese
patients presenting to cardiac surgery is ever increasing.
Laparoscopic Adjustable Gastric Banding (LAGB) is one
modality commonly used to mechanically reduce food
intake and also promotes early satiety. Late complications
of the device may occur in up to 20% of cases; increasing
up to 30% in pregnancy. We report the first case of a late
complication of LAGB after cardiopulmonary bypass.
Aims/Objectives
A 51 year old female with symptomatic, severe mitral
valve regurgitation presented for elective mitral surgery.
She had a history of atrial fibrillation, and insertion of
LAGB two years previously. The patient underwent
successful mitral valve repair using a 30 mm Cosgrove ring.
Trans-oesophageal echocardiogram showed a competent
valve, although transgastric views were avoided to
prevent displacement of the gastric band. Post-operative
recovery was uneventful and the patient was stepped
down to the ward promptly. Diuretics were discontinued
when the patient returned to pre-operative weight.
Method
The following day the patient complained of nausea and
non-bilious vomiting. Her symptoms persisted despite
cessation of opioid analgesia and commencing
antiemetics. There were no significant clinical findings. Blood
biochemistry and plain x-ray films were unremarkable.
Results
A gastrografin swallow showed that contrast failed to pass
through the gastro-oesophageal junction. The gastric band
balloon was deflated by 0.6 ml. Oral intake was resumed
and she was discharged home. There was no residual
dysphagia at follow up.
Discussion/Conclusion
The most common causes of postoperative nausea and
vomiting are drug-induced emesis, paralytic ileus,
obstruction or mesenteric ischaemia. Where patients
have been stable with an LAGB in situ for some time,
this can make the diagnosis of gastric inflow obstruction
challenging.
One possible explanation for the acute deterioration of
an established LAGB following cardiac surgery is
subacute oedema in the stomach wall at the site of the gastric
band. Fluid retention and post-operative gut distension.
Gastric band obstruction should be considered if such
patients develop upper gastro-intestinal. An early
gastrografin swallow should be considered.
Consent
Written informed consent was obtained from the patient
for publication of this abstract and any accompanying
images. A copy of the written consent is available for
review by the Editor of this journal. (...truncated)
This is a preview of a remote PDF: http://www.cardiothoracicsurgery.org/content/pdf/1749-8090-10-S1-A170.pdf
Raed Azzam, Abdelrahman Abdelbar, Andrew Brazier, Bilal H Kirmani, Ragheb Hasan.
Acute gastric obstruction following cardiopulmonary bypass in a patient with an adjustable gastric band ,
Journal of Cardiothoracic Surgery,
2015, pp. A170, 10,