F21 C C Melena Onset1 day ago Past

Past history : Laparoscopic adjustable gastric banding (2009. 10. 24) : Diagnostic laparoscopy &

Review of system Weight loss (+) (70 kg/156 cm 65. 2 kg, BMI 28.

Physical examination V/S : 100/50 -118 -16 -38. 4℃ G/A Acute ill looking appearance,

Physical examination Abdomen Peri-umbilical op. scar Increased bowel sound Direct tenderness on sub-umbilical area

Laboratory findings CBC 373 K Chemistry T. pro/Alb AST/ALP/r. GT T. bilirubin BUN/Cr CRP

Impression Gastric ulcer bleeding Erosion d/t Laparoscopic adjustable gastric banding R/O hematoma around band

Topic review ADJUSTABLE GASTRIC LAP-BANDING

Laparoscopic adjustable gastric banding Belachew and colleagues The most frequently performed bariatric procedure Placement

LAGB ; Complication Dilatation 3. 97% Dislocation of band 1. 62% Port rotation/ movement

Slides: 22

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F/21 C. C : Melena Onset>1 day ago

Past history : Laparoscopic adjustable gastric banding (2009. 10. 24) : Diagnostic laparoscopy & appendectomy - Hemorrhage of ovarian cyst (2009. 11. 5) Family & Social history : non specific

Review of system Weight loss (+) (70 kg/156 cm 65. 2 kg, BMI 28. 76 26. 79) Poor oral intake (+) Fever /Chill (+/-) Nausea/ Vomiting (+/-) Abdominal pain/discomfort (+/+) Melena/ hematochezia/hematemesis (+/-/-)

Physical examination V/S : 100/50 -118 -16 -38. 4℃ G/A Acute ill looking appearance, Alert mentality HEENT Anicteric sclera Pale conjunctiva Slightly dehydrated tongue and lip Chest Clear breathing sound without crackle and

Physical examination Abdomen Peri-umbilical op. scar Increased bowel sound Direct tenderness on sub-umbilical area Induration of port insertion site (counter Mc. Burney point) Back & Extremitities No pitting edema, No CVA tenderness

Laboratory findings CBC 373 K Chemistry T. pro/Alb AST/ALP/r. GT T. bilirubin BUN/Cr CRP Electrolyte(Na/K/Cl) 23. 820 -9. 1/26. 46. 0/3. 6 19/7/57/12 0. 4 17. 8/0. 8 1. 58 141/4. 3/106

Simple X ray

CT abdomen

Impression Gastric ulcer bleeding Erosion d/t Laparoscopic adjustable gastric banding R/O hematoma around band port R/O abscess formation around band port & catheter related infection

HD #2

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HD #7

Clinical course

Topic review ADJUSTABLE GASTRIC LAP-BANDING

Laparoscopic adjustable gastric banding Belachew and colleagues The most frequently performed bariatric procedure Placement of an implantable silicone band around the upper stomach, creating a channel between a small proximal pouch and the distal stomach To restrict intake and result in early satiety

Laparoscopic adjustable gastric banding

LAGB ; Complication Dilatation 3. 97% Dislocation of band 1. 62% Port rotation/ movement 0. 87% Cath. Rupture/ disconnection/leak 0. 80% Erosion 0. 59% Infection of band reservoir 0. 36% Wound infection 0. 28% Bleeding (GI) 0. 05% Surgery 2004; 135: 326 -51

F/23 AJR 2005; 184: 109 -112

M/40 OBES SURG 2008; 18: 163639

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