Obstructive jaundice: a rare complication of laparoscopic greater curvature plication
A 24-year-old female, who had undergone laparoscopic greater curvature plication (LGCP) 6 months earlier, presented to the emergency room with 1 day history of severe epigastric pain, associated with nausea. She also complained of yellow discoloration of skin and dark urine.\nOn examination, she was jaundiced. Vital signs were as follows: temperature 38°C, heart rate 120 bpm, blood pressure 140/87. Abdominal examination revealed marked tenderness at the epigastric and peri-umbilical areas, with guarding. White blood cells count was 12.8 × 109/l and haemoglobin count was 109 g/l. Renal profile was within normal. Total bilirubin was elevated at 74.1 mmol/l, and the reminder of liver function test was within normal.\nAn ultrasound of abdomen showed distended gallbladder with no calculi, dilated CBD and mild intra-hepatic biliary radicles dilatation. Stomach and duodenum were shown to be grossly dilated. The CT scan of the abdomen showed gastric outlet obstruction with an abnormal position of gastro-duodenal junction. Gastric mucosal prolapsed with mass effect on duodenum (and ampulla of Vater) and secondary dilatation of the biliary and pancreatic ducts.\nUpper GI endoscopy showed the status post gastric plication with herniation of gastric fold into the duodenum. An attempt was made to manipulate the fold but was not successful (Fig. ).\nThe patient underwent exploratory laparotomy, and anterior gastrotomy. The mucosal fold was delivered relieving the obstruction. The redundant mucosa was transacted by a linear cutter stapler (Fig. ) and the gastrotomy closed primarily.\nThe post-operative course was unremarkable, with gradual normalization of total bilirubin.