Bolus Obstruction of Pouch Outlet by a Granular Bulk Laxative after Gastric Banding

Authors: Herrle, Florian; Peters, Thomas; Lang, Claudio; von Fluee, Markus; Kern, Beatrice; Peterli, Ralph

Source: Obesity Surgery, Volume 14, Number 7, August 2004 , pp. 1022-1024(3)

Publisher: Springer

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Abstract:

Background: Constipation is an occasional problem after gastric banding and is often caused by insufficient liquid intake. As a result, the use of laxatives is widespread in such patients. Depending on the laxative, improper use can lead to bolus obstruction above the band, as occurred in this case. Case Report: A 59-year-old female with uncomplicated laparoscopic adjustable gastric banding presented 2 months after surgery with food and liquid intolerance and dysphagia after ingestion of a granular bulking laxative. Despite deflating the band, the bolus could not be washed out. Endoscopic extraction was required, revealing a 4×2 cm bolus of the laxative and a small compression ulcer. Discussion: Patients not complying with nutritional recommendations after gastric banding may have insufficient liquid intake and, consequently, constipation. Under these conditions, the use of a granular bulking laxative entails the risk of esophageal obstruction above the band. Conclusion: Nutritional counseling after gastric banding should include the recommendation of liquid intake of at least 1.5 l/day. If constipation occurs, osmotic or paraffin oil laxatives should be used instead of bulking laxatives.

Keywords: MORBID OBESITY; BARIATRIC SURGERY; GASTRIC BANDING COMPLICATION; CONSTIPATION; LAXATIVES/AGIOLAX &REG; NUTRITIONAL BEHAVIOR; LIQUID INTAKE

Document Type: Research article

DOI: http://dx.doi.org/10.1381/0960892041719563

Publication date: 2004-08-01

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