A 42‐year‐old woman with multiple sclerosis presented with cough, fever, and malaise. The patient had been admitted 2 weeks prior with similar symptoms; she was given a diagnosis of community‐acquired pneumonia and discharged with oral antibiotics, but symptoms persisted. Her multiple sclerosis was controlled on natalizumab without functional limitations. Medical history was otherwise significant for laparoscopic adjustable gastric banding in 2007. On admission, examination revealed a low‐grade temperature of 99°F and normal oxygen saturation on room air. Lungs were clear to auscultation bilaterally. White blood cell count was 37,000 cells/μL with bandemia. Chest radiograph was unremarkable. Chest computed tomography (CT) revealed bilateral ground‐glass opacities, and plans were made for inpatient bronchoscopy.
Recurrent pulmonary symptoms and bilateral pulmonary ground‐glass opacities in a patient on immunomodulatory therapy yield an extensive differential diagnosis that includes resistant bacterial pathogens, opportunistic fungal and viral pathogens and interstitial lung diseases. However, the diagnosis in this case was made by returning to the bedside. Further history revealed that the patient's cough occurred exclusively at night, specifically while she was lying flat. She described an associated sensation of “a column of fluid coming up my chest.” Her gastric band had been tightened in an outpatient visit with her surgeon approximately one week prior to developing all pulmonary symptoms. On further review, the chest CT demonstrated a dilated, fluid‐filled esophagus suggestive of distal restriction. Laparoscopic adjustable gastric banding is currently the least invasive surgical intervention for morbid obesity. Commonly encountered late complications of this procedure include pouch expansion and band slippage or erosion; less frequent are late pulmonary complications, such as recurrent aspiration pneumonia due to severe restriction. The patient's surgeon withdrew all fluid from her gastric band, with immediate symptomatic relief. Bronchoscopy was cancelled. She was discharged the following day with oral antibiotics, and her symptoms did not recur.
(1) Surgical procedures for morbid obesity are increasing in frequency, and hospitalists require knowledge of commonly encountered complications of each procedure. (2) Recurrent aspiration is an infrequent but important late complication of laparoscopic adjustable gastric banding, which can be definitively addressed by fluid removal from the gastric band.
To cite this abstract:Sankey C. Recurrent Aspiration As a Complication of Gastric Banding. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 453. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/recurrent-aspiration-as-a-complication-of-gastric-banding/. Accessed March 31, 2020.