Introduction: Obesity is a major public health issue, with increasing prevalence in western societies. Since 1993, Laparoscopic Adjustable Gastric Band (LAGB) is gradually being replaced in many institutions by other surgical techniques for weight loss, due to high inherent complications.The authors present a rare case of caecal volvulus caused by LAGB inserted 11 years prior.
Methods: A 65 year old lady presented with a one day history of abdominal pain. Her past medical history included a LAGB placed 11 years prior, which achieved 11kg weight loss, 3.8kg/m2 body mass index (BMI) reduction, 9.17% weight loss, and 23.04% excess weight loss during this time. For several months prior, she also described of intermittent abdominal bloating and colicky abdominal pain. Her abdomen was mildly distended, and tender in the periumbilical and lower quadrants with no peritonism. Her inflammatory markers were normal. Computed Tomography scan demonstrated a cecal volvulus with displacement of cecum towards the upper abdomen with dilatation of up to 10cm, with twisting of the ascending colon and terminal ileum inferior to the cecum from the LABG tubing.
Major Findings: Laparotomy demonstrated a cecal volvulus associated with the LAGB tubing, which had wrapped and twisted around the cecal mesentery. Macroscopically, the cecum appeared chronically dilated, with no acute compromise to the bowel wall. A limited right hemi-colectomy, and removal of gastric band and port was performed. Histopathology demonstrated benign reactive changes. She made an uneventful postoperative recovery.
Conclusion: LAGB accounts for only 5.5% of all bariatric surgeries. This has largely been due to reported removal rates of up to 40% after 7 years secondary to complications. Only four other case reports of cecal volvulus from LAGB have been described. Surgeons should have a high index of suspicion of a volvulus in a patient with an acute abdomen as a late complication of LAGB.