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Homero Rivas, MD; Robert Cacchione, MD; Jeff W. Allen, MD
From the Department of Surgery, University of Louisville School of Medicine, and the Center for Advanced Surgical Technologies, Louisville, Ky.

Arch Surg. 2004;139:1127-1128.

INTRODUCTION
A 44-year-old female patient had epigastric pain after several episodes of vomiting. Three months ago she had undergone laparoscopic gastric banding for morbid obesity. She had not experienced any problems prior to this presentation, and her body mass index (BMI) had dropped from 50.1 to 41.0 kg/m². Her physical examination results and prior medical history were unremarkable. A swallow study (Figure 1) and laparoscopic image of the stomach (Figure 2) are shown.

View larger version (218K): [in this window] [in a new window] Figure 1.

View larger version (86K): [in this window] [in a new window] Figure 2.

What Is the Diagnosis?

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A. Intra-abdominal migration of the band

B. Paraesophageal hernia

C. Slippage of stomach through an adjustable gastric Lap-Band

D. Over-tightening of the band

E. Erosion of the band

Answer

SECTION EDITOR: GRACE S. ROZYCKI, MD

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Image of the Month—Diagnosis
Arch Surg. 2004;139(10):1127-1128.
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