Complications of gastric banding presenting to the ED

Although laparoscopic adjustable gastric banding has become a widely used surgical modality for the treatment of morbid obesity, the technique and its complications remain fairly unknown to the medical community in general. Late complications occur in 10% to 20% of patients and usually manifest as upper gastrointestinal symptoms such as total food intolerance. However, seemingly unrelated symptoms such as chest pain may be the primary complaint. A rare but important complication to recognize and treat is gastric necrosis due to herniation of the stomach through the band. From the lessons learned with 2 patients and review of the literature, the diagnostic pitfalls and means for achieving a prompt diagnosis are discussed and a management protocol intended for emergency department staff is provided.