Acute appendicitis as a rare complication of gastric band
A 29-year-old female patient was admitted into the surgical department of Nicosia General Hospital because of a lower abdominal intermittent and cramping pain for the last 24 h. On physical examination, the patient had sensitivity during palpation at the lower abdomen, more predominant at the right iliac fossa. Rebound tenderness was absent during the first examination, as well as the rest of the signs of acute appendicitis. The patient had the following laboratory blood test results: WBC 9.25 × 109/l, neutrophils 69.3%, lymphocytes 20.0%, Mon 9.3%, HGB 9.7 g/dl, HcT 31.3%, MCV 69.4 fl, MCH 21.5 pg, MCHb 31.0 g/dl, PLT 220 × 109/l, glucose 116 mg/dl, urea 18 mg/dl, creatinine 0.8 g/l, Na 139 mmol/l, K 3.9 mmol/l, Tbil 0.81 mg/dl, ALP 61 U/l, γ-GT 8 U/l, AST 10 U/l, ALT 14 U/l, LDH 325 U/l and amylase 103 U/l. Urine test showed no urinary infection and pregnancy test was also negative. Plain chest and abdominal X-rays showed no pathology. Because of her persistent pain and the unclear symptoms that prevented a final diagnosis to be made, she had an ultrasound of the abdomen. The ultrasound revealed a small amount of fluid at the right iliac fossa, and revealed no other pathology of the appendix or any other internal organ. From her past medical history, a laparoscopic procedure for gastric band implantation due to obesity was recorded five years ago. The gastric band worked perfectly well and she lost about 30 kg. She did not complain for any abdominal pain that could be connected to the gastric band, and she did not have any symptoms from erosion or migration of the band. A small flip-over of the port of the gastric band was reported by the patient and it was noted on clinical examination.\nAfter 2 days of hospitalization, observations and clinical examination, she developed acute peritonitis, so she was taken to the operating theatre. A sub-umbilical midline incision was executed to have a good access to the abdomen.\nThe peritoneal cavity was entered and the lower abdomen was thoroughly explored. Signs of infection were noted in the right iliac fossa. The appendix was attached to the ovary and pus was around them. During careful dissection, a strangulation of appendix's lumen from the tube of the gastric band was noted (Figs and ). The tube encircled the appendix and caused the intraluminal disruption that initiated the process of infection. We released the adhesions between the appendix and the tube and proceed to appendectomy. We then narrowed the length of the tube to prevent any future complications, e.g. intestinal obstruction, and thoroughly washed out the peritoneal cavity.