Endoscopic Diagnosis of Gastric Fold Herniation

Clinical Image

Ann Obes Disord. 2016;1(3): 1015.

Endoscopic Diagnosis of Gastric Fold Herniation

Tai CM1,2, Tsai MS2,3 and Yu ML4,5,6,7*

¹Department of Internal Medicine, I-Shou University, Taiwan

²Department of Bariatric and Metabolic Surgery Center, I-Shou University, Taiwan

³Department of Surgery, I-Shou University, Kaohsiung, Taiwan

4Institute of Clinical Medicine, Kaohsiung Medical University, Taiwan

5Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Taiwan

6Institute of Internal Medicine, Kaohsiung Medical University, Taiwan

7Institute of Biomedical Sciences, National Sun Yat-Sen University, Taiwan

*Corresponding author: Ming-Lung Yu, Department of Internal Medicine, Kaohsiung Medical University Hospital, Hepatobiliary Division, 100 Tzyou Road, Kaohsiung City 807, Taiwan

Received: October 17, 2016; Accepted: October 20, 2016; Published: October 24, 2016

Clinical Image

A 40-year-old male underwent Laparoscopic Adjustable Gastric Banded Plication (LAGBP) for morbid obesity 4 years ago. He reported having upper abdominal pain for the past 2 months, and had mild tenderness to palpation in the epigastric area. Esophagogastroduodenoscopy disclosed a 0.6-cm hole on the plicated fold at the gastric fundus (Figure 1A). One large pouch with visible gastric folds was found behind the hole. The mucosa of the pouch was congested (Figure 1B).

Abdominal computed tomography revealed a herniated pouch with a thin gastric wall at the fundus (Figure 2). Laparoscopy revealed gastric fold herniation with congested gastric wall. The plication sutures were released, and the patient’s symptoms subsided. Gastric Fold Herniation (GFH) is one of the most serious complications after LAGBP and reoperation is usually needed [1,2]. Gastric necrosis requires resection, but deplication of the folds could relieve the symptoms if the herniated folds are only congested [3].