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Gastric Band AdjustmentCase Study

31/10/2009

Done by: Shatha Jamal Al-MushaytPresented for: Dr. Abdullah Al-Huwaimel

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Patient information

Gender: Female Age: 29 years old Nationality: Saudi Professional diagnosis: Morbid Obesity Patient history: Gastric band surgery 5

years ago Exam type: Gastric Band Adjustment

she could not reach the required weight..(still obese)

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Contrast Media (CM)

Type: Barium sulfate -340 g

Preparation of CM: mixed with water Poured in a cup To be Swallowed by mouth

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Patient preparation

Patient had nothing by mouth for 4 hours before exam

No pregnancy the patient was free of any

object that may superimpose interested anatomic part under x-ray

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Procedure Equipment

Fluoroscopic unit Cotton pads Antiseptic fluid Needle & syringe Saline Pen marker Gastric band existed inside the

patient body

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Gastric Band System

Gastric band (silicone ring)

tube

access port

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How was Gastric band inserted by surgeon?

The band was inserted around the upper part of the stomach

The access port was placed just under the skin

The tube connect between them

>> See image

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Inserted Gastric Band

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Inserted Gastric Band

Inserted band forms a small stomach pouch less food is stored in the stomach, feel full sooner

Band size is controlled by Injection or withdrawn of Saline.

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Inserted Gastric Band

The inner surface of the band ring is a balloon-like

Injection to tighten the band Withdrawn to loose the band

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Procedure’s Steps

Patient was lying down on the x-ray table

Palin radiograph was taken: AP supine, KV: 96

Table then was tilted up to 44 degrees –fowler's position

(to prevent the normal reflux while CM drinking)

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- The radiologist located the access port under x-ray & marked it- he sterilized the place by antiseptic cotton pad and inserted the needle into the port

Procedure’s Steps

The needle

“Plain film of this case patient”

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Procedure’s Steps

the patient was instructed to collect the Barium sulfate in her mouth and swallow it at once

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Procedure’s Steps

In this case, Saline was injected by the syringe & needle to tight the band

Remember ! “she could not reach the required weight..(still obese) “

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Procedure’s Steps

The tight level depends on the patient’s comfort, displayed image and radiologist’s

opinion

End of the procedure

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Result(finding)

About 2 ml of saline was infused into the band

Re-evaluation after adjustment shows: Passage of contrast to the stomach

and Satisfaction of the patient

Dictating doctor, Dima JamjoomSigning and approving doctor, Al bager Naser Elbagir Nasir

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After Care

Since the patient was satisfied with the band size while swallowing, she could go home.

It was recommend to have a smooth meal the day of procedure

The following day, must be able to eat normally

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My Comment

Patient felt little pain while inserting the needle. So, I wondered why did they not use local anesthesia to numb the skin?!

The procedure wasinteresting.

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Morbid Obesity

Obesity is an abnormal accumulation of fat.

20-40% over the ideal weight mild obesity 40-100%moderate obesity 100% morbid obesity

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Morbid Obesity

Obesity considered morbid when it significantly increases the risk of obesity-related health conditions or serious diseases

It is considered serious “chronic” disease: symptoms occur slowly over long period of time

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Obesity In General

Is one of the most serious public health issues of the 21st century

Is a leading cause of death worldwide with increasing prevalence in adults and kids;

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Causes

Most commonly caused by a combination of:1. excessive dietary calories, 2. lack of physical activity

If a person eats more calories than he/she burns ,the person gains weight as the body stores the excess energy as fat

Other causes: A. genetic susceptibilityB. medical reasons. e.g. hypothyroidismC. psychiatric illness

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Symptoms & Obesity-Related Health Conditions

Major symptoms: Excessive weight gain & the large amounts of fatty

tissue

Obesity-Related Health Conditions: Hypertension Type II Diabetes Hypercholesterolemia Decreased fertility & pregnancy complications Gallstones Sleeping disorders etc.

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Treatment

Obesity is difficult to treat & weight may be regained.

Diet, exercises are primary treatments

Surgeries for sever cases

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Hope You Like It ! Thank You

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Reference

http://www.urmc.rochester.edu/hh/services-centers/bariatrics/morbid-obesity.cfm

http://medicaldictionary.thefreedictionary.com/Obesity%2c+morbid

http://en.wikipedia.org/wiki/Obesity#Causes

http://www.medicinenet.com/obesity_weight_loss/article.htm