Biofilm-sealed perforation of the gastric body: a rare sequela of gastric band erosion

Laparoscopic Adjustable Gastric Banding is one of the cardinal bariatric interventions and due to its early safety profile, became the mainstay. Major long-term complications of gastric banding include pouch-herniation-dilation and gastric erosion. A 59-year-old female presented to the emergency department with a 2-week history of progressive central abdominal pain and distention on a background history of a laparoscopic adjustable band insertion 11 years previously. Subsequent computed tomography demonstrated an intragastric band erosion. An exploratory laparotomy demonstrated a gastric band eroded through the stomach sealed by a biofilm. Secondary findings included small bowel ischemia and portal vein thrombosis. The gastric band was extracted, and the stomach was repaired. The ischemic small bowel was resected with primary anastomosis. The patient recovered uneventfully. Gastric band erosion should be considered in all patients presenting with abdominal pain and previous weight loss surgery. Prompt recognition may avoid fatal consequences.

An unusual case of a completely eroded gastric band and port tubing removed via endoscopy alone

Bariatric surgery is an established intervention providing significant health benefits to patients with obesity. As a result, the National Institute for Health and Care Excellence now recommends bariatric surgery for those that fulfil the eligibility criteria, while emphasising the need for multidisciplinary care before and after surgery. The UK National Bariatric Surgery Registry shows gastric band procedures to be the second most common bariatric procedure performed in the UK. Gastric band erosion is a known potential complication treated primarily by laparoscopic removal of band and repair of stomach. To our knowledge, we present the first case of a partially eroded gastric band with separate gastric fistulation of the port tubing. The band was removed via endoscopy without the need for a cutaneous exploration as the port had previously been removed at incisional hernia surgery. Owing to the fact that the tubing and band were both evident within the lumen of the stomach, complete band erosion was inferred and therefore endoscopic removal thought to be indicated. In actual fact, there was separate erosion of the band and tubing; more specifically, the gastric band clasp had not eroded fully and while endoscopic removal was still possible, it was challenging and required the band to be divided. This case highlights the importance of careful patient selection, involvement of multidisciplinary care prior and after surgery and close follow-up to facilitate timely identification and management of complications.

Impact of Hydrological Study to Water Quality Status in Kuantan River, Pahang, Malaysia

Water is a vital for all aspects of human and ecosystem survival. The evaluations of water quality parameters and hydrological status are necessary to enhance the performance of an assessment operation and develop better water resources management and plan. There are three sampling stations were selected along the Kuantan River. Seven water quality parameters were measured and Malaysian Department of Environment Water Quality Index (DOE-WQI) was calculated and classified based on the National Water Quality Standard, Malaysia (INWQS). The water balance status applied to determine the stability of inflows and outflows into and from the basin. As a result, all water quality parameters (DO, COD, BOD, TSS, NH3-N and pH) which categorized under the ranged of class II until class IV respectively. Kuantan River located in Pahang state, Malaysia which is significantly degrading due to human activities as well as urbanization in and within the area. Overall, the result showed that the estimated average sediment that flows out of Kuantan Rivers is 108.88tonnes/day (24 February 2017) and 44.917 tonnes/day (30 April 2017). The contributors of sedimentation problems in Kuantan River are from unsustainable land use such as urbanization and industrialization which trapping the bed sediments and river band erosion.