Bolus obstruction of pouch outlet by a granular bulk laxative after gastric banding

Obesity Surgery
Florian HerrleRalph Peterli

Abstract

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. 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 4x2 cm bolus of the laxative and a small compression ulcer. 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. 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.

Citations

Jan 25, 2007·The Consultant Pharmacist : the Journal of the American Society of Consultant Pharmacists·Jeannette Y Wick
Oct 28, 2008·Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery·Kevin M ReavisNinh T Nguyen
Mar 17, 2015·Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery·Xavier DrayThierry Tuszynski
Jul 22, 2017·Clinical Journal of Gastroenterology·Sern Wei Yeoh

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