2017-09-06 20:58:09 UTC

Image Challenge: Complaints of Dysphagia and Heartburn After Bariatric Surgeries?

Sept. 6, 2017

The patient had an adjustable gastric band migrate, Roux-en-Y gastric bypass fail and a supportive band placed on the gastric pouch fail.

Gastroenterology Clinical Image Challenge: A 43-year-old woman presented for management of a complication of her bariatric surgery. The history goes back to September 2000 when the patient presented with a body mass index (BMI) of 45 (120 kg to 1.63 m). An adjustable gastric band was placed. One year postoperatively, the band migrated, which resulted in removal of the band. In 2003, the patient regained weight and reached a BMI of 47 kg/m2. She underwent a Roux-en-Y gastric bypass. The Roux-en-Y gastric bypass failed in the long term; the patient regained weight and reached a BMI of 45. A supportive band was also placed on the gastric pouch and failed to result in significant weight loss, which necessitated its removal.

Currently, the patient has a BMI of 55 and she complains of heartburn accompanied by intermittent abdominal epigastric pain and dysphagia for solid food for the last few months. A 3-dimensional thoracoabdominal computed tomography (CT) scan was done (Figure).

What is the diagnosis and how it should be managed?

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