Unusual Bariatric Complication in Pregnancy

A 21-year old woman, G1P0, was admitted to our University Hospital at 33 weeks and 2 days of gestational age with a 1 week history of nausea and vomiting and doubled transaminases. Two years before she underwent laparoscopic adjusted gastric banding (LAGB). The estimated fetal weight was 1960 grams (corresponding with P25), doppler measurements were all normal. There was an anhydramnion. Because of gestational age, betamethasone 12 mg was administered twice intramuscularly, with an interval of 24 hours. Because of clinical and biochemical deterioration a primary cesarean section was performed based on the suspicion of a HELLP syndrome. Subsequent to the caesarean section, the epigastric pain, nausea and vomiting persisted. An esophagogastroduodenoscopy (EGD) was performed and showed serious band slipping. The patient was planned for urgent laparoscopy. At laparoscopy, a gigantic edematous stomach was seen (size comparable to a 40 weeks gravid uterus), as well as ascites. At exploration, not only a slipping of the gastric band was seen, but also a torsion of the stomach. The postoperative phase was uneventful. One month later, the patient was seen in the outpatient clinic without digestive symptoms.