Hematemesis From a Left Gastric Artery Pseudoaneurysm Secondary to an Adjustable Laparoscopic Gastric Band

Abstract

Gastric band erosion into the lumen of the stomach or the esophagus is a fairly common but often underreported complication of laparoscopic adjustable gastric banding surgery. It occurs in as many as 3-11% of patients who undergo the procedure. We present here the case of a 56-year-old morbidly obese female who developed the sudden onset of hematemesis and dysphagia more than 3 years after laparoscopic gastric band placement. Endoscopy was performed at presentation and revealed erosion into the proximal gastric lumen. The patient was stabilized with medical management of her anemia and abdominal pain. Both the band and subcutaneous reservoir were subsequently removed laparoscopically. A perforation of the gastric wall was identified and treated with a falciform ligament patch and naso-gastric decompression. Five days after surgical band removal, the patient had an episode of hematemesis productive of over 750 cc of blood, accompanied by tachycardia and hypotension. Mesenteric (celiac artery) angiography revealed an actively bleeding pseudoaneurysm of the left gastric artery that was successfully thrombosed with coils. The patient was kept nil per os (NPO) on total parenteral nutrition (TPN) for 1 week postoperatively and remained stable. A follow-up gastrograffin upper gastrointestinal (GI) study showed no leak from the perforation site. To our knowledge, this is the first reported case in which an erosion from an adjustable laparoscopic gastric band was associated with massive upper GI bleeding from a left gastric artery pseudoaneurysm. The case demonstrates the importance of monitoring a patient with hematemesis post lap band surgery, as life-threatening bleeding may persist after removal of the gastric band.




J Curr Surg. 2014;4(3):95-98
doi: http://dx.doi.org/10.14740/jcs234w