How Do You Manage Bariatric Surgery Complications?

Case Recap:
You are called to the bedside of patient who presents for nausea and vomiting. He is a 38-year-old man who is 2 weeks out from the placement of a laparoscopic adjustable gastric band. He reports that he had an acute onset of nausea and vomiting this evening. He is actively vomiting on presentation and complains of diffuse abdominal pain, but is hemodynamically stable. While attempting to contact his surgeon, you wonder what the best imaging modality is to make the diagnosis. What would you do?

Case Conclusion:
You returned to your patient, in whom you had a concern for a slipped gastric band. You considered obtaining either an upper GI series or CT scan with oral and IV contrast; after speaking to his surgeon, you decided on an upper GI series, as the patient was now more stable. The patient was admitted to the surgery service; on follow-up, you learned that the balloon was subsequently deflated/repositioned, and the patient was discharged home in stable condition.

2 thoughts on “How Do You Manage Bariatric Surgery Complications?

  1. That seems like an odd choice of imaging – I would think a CT with po contrast would be the better study to define the anatomy, the gastric band, and any possible extravesation of a perforation which would be an emergency. An xray will not give all of that info, would it?

    ps – not really looking to have my name published world wide if this comment goes anywhere beyond the trash can…lets keep it annonymous?!

  2. X-ray would actually be my first choice since this would give a quicker result to something that may need emergent intervention, given his recent operative history. If there is free air, a CT is not required, although helpful, and the patient would likely be in the OR sooner. If the plain film does not indicate an issue, then a CT may be needed in order to diagnose the problem. CT scans, especially if waiting for PO contrast, are very time consuming. Makes total sense. Thanks for the great case study!

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