Background

A 73-year-old female was admitted with a fall history after 3-weeks of nausea, abdominal pain, and PO intolerance. She had an older generation 10.0 gastric band placed in Mexico 7 years before presentation. After which, she never followed up with a bariatric surgeon. CT scan with IV contrast showed fluid buildup along the gastric band catheter with two rim-enhancing regions concerning for multiple abscesses. On physical exam, she was tender to palpation over the port site, but there was no erythema or drainage. Endoscopy was performed, which showed evidence of a partially eroded lap band best seen at the retroflexion. Clinically, the patient had a fever and white count elevation to 15. Intra-operatively, we found multiple pockets of frank pus surrounding the gastric band catheter. When we removed the band, we found a significant gastrotomy due to the erosion (approximately 270 degrees) just distal to the GE junction. We dissected the crus to get to healthy esophageal tissue proximal to the GE junction to repair the gastrotomy. This was repaired in 2 layers, and then the hiatus was repaired. A bubble test with endoscopy was performed without evidence of a leak, and a drain was placed in the LUQ. An UGI study was completed the next day, also without a leak. She was discharged three days following surgery. She was admitted to the hospital 1-week later for fatigue and dehydration. At her 1-month follow-up, she was doing well with no new complaints.