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ENDOSCOPIC REMOVAL OF GASTRIC BAND WITH SMALL BOWEL OBSTRUCTION

Gastric banding is a popular treatment for morbid obesity. Band erosion leading to intraluminal migration or intrusion occurs uncommonly. We report a rare case of endoscopic removal of a migrated gastric band resulting in small bowel obstruction A 31-year-old woman who had undergone vertical banded gastroplasty laparoscopically for the treatment of morbid obesity 2 years prior was admitted to our emergency room with periumbilical pain for 3 days. Physical examination revealed increased bowel sounds and mild direct tenderness on the periumbilical area without peritoneal irritation sign. A plain film showed multiple air fluid levels and a band lying in the central abdomen (Fig. 1). Computed tomography (CT) demonstrated that the band was lying within the jejunum. After conservative therapy for 3 days, her symptoms and physical examination did not change.We planned to carry out laparoscopic exploration. Follow-up X-ray and CT confirmed intraluminal band location in the distal ileum. No evidence of free gas or air bubbles was found. We tried to remove the band endoscopically. Colonoscopy showed the impacted band within the distal ileum and a distally located connecting tube (Fig. 2).The surrounding mucosa was erythematous and edematous. The impacted band did not move through repetitive trial by long forceps, snare and net. The snare was passed via the distally located cable and crossed the center of the band ring carefully. Then the band was removed and retrieved without immediate complication. The patient was discharged on the fifth day after the procedure. Small bowel obstruction following intragastric band migration is relatively rare and its consequence could be underestimated. In rare cases, laparoscopic extraction methods have been carried out to remove it. However, if there is evidence that the band has migrated distally to the ileum and the patient’s condition is stable, then colonoscopic removal may be preferred to retrieve the band carefully as in the present case.