Slipped gastric band

Gastric band alignment is different in the two projections and abnormally horizontal in the erect projection suggesting slippage. No features to suggest perforation.

Cholecystectomy. Gasless small bowel most likely reflects vomiting. A small amount of gas is seen in non-distended colon.

Lap band device noted in situ. The phi angle measures 60 degrees. There is no extraluminal contrast extravasation from the well distended stomach. No surrounding stranding.

There is no free fluid or free gas.

Evidence of previous cholecystectomy is noted. The liver, spleen, adrenal glands and pancreas are normal in appearance. Mild prominence of the common bile duct is likely secondary to previous cholecystectomy. Small hypodense renal lesions are most likely cysts however these are too small to be adequately assessed on this study. Presumed previous hysterectomy. The surgical clip projected within the left hemipelvis likely secondary to prior tubal ligation. No bowel abnormality.

Apart from mild atelectasis, the lung bases are clear.

Conclusion

Findings are most consistent with collapse and slippage with the phi angle measuring 60 degrees;. No CT evidence of extraluminal contrast extravasation from the stomach. No other potential cause for the patient's pain is identified.

Barium swallow

Technique:

Barium swallow was performed with the patient in the erect position, initially with liquid barium, then with barium-soaked bread.

Preliminary screening fluoroscopy shows gastric lap band oriented closer to horizontal than to vertical with a gas bubble proximal to it. Delayed transit was observed through the esophagus during both liquid and solid components of the study. Contrast outlines a small pouch proximal to the lap band. Contrast and food material passes through the lap band into the body of the stomach.

Conclusion

Slipped gastric lap band with proximal pouch formation. Delayed esophageal transit to both solids and liquids.