이정현, 설동춘, 고순영, 김병국, 김정환, 성인경, 박형석, 심찬섭 제 86회 소화기내시경 집담회 흑색변을 주소로 내원한 21세 여자 건국대학교병원 소화기병센터 이정현, 설동춘, 고순영, 김병국, 김정환, 성인경, 박형석, 심찬섭

F/21 C.C : Melena Onset>1 day ago

Present illness 평소 70kg(156cm) 정도의 체중을 가지고 있던 환자 는 내원 20여 일 전 체중감량을 위하여 복강경을 이용한 위 밴드 수술을 하였고 내원 전일 부터 발생한 복통과 5~6회의 흑색변으로 개인의원 방문하여 위 내시경 시 행 받고 출혈 소견 없다는 이야기 들었으나 지속적인 흑색변 있어 내원함 체중과 키를 언급

Past history Past history Family & Social history : Laparoscopic adjustable gastric banding (2009.10.24) : Diagnostic laparoscopy & appendectomy - Hemorrhage of ovarian cyst (2009.11. 5) Family & Social history : non specific

Review of system Weight loss (+) (70kg/156cm65.2kg, BMI 28.7626.79) Poor oral intake (+) Fever /Chill (+/-) Nausea/ Vomiting (+/-) Abdominal pain/discomfort (+/+) Melena/ hematochezia/hematemesis (+/-/-) 2장으로 만들기

Physical examination V/S : 100/50-118-16-38.4℃ G/A Acute ill looking appearance, Alert mentality HEENT Anicteric sclera Pale conjunctiva Slightly dehydrated tongue and lip Chest Clear breathing sound without crackle and wheezing

Physical examination Abdomen Peri-umbilical op. scar Increased bowel sound Direct tenderness on sub-umbilical area Induration of port insertion site (counter McBurney point) Back & Extremitities No pitting edema, No CVA tenderness

Laboratory findings CBC 23.820-9.1/26.4-373K Chemistry T.pro/Alb 6.0/3.6 AST/ALT/ALP/rGT 19/7/57/12 T. bilirubin 0.4 BUN/Cr 17.8/0.8 CRP 1.58 Electrolyte(Na/K/Cl) 141/4.3/106

Simple X ray

CT abdomen

Impression Gastric ulcer bleeding Erosion d/t Laparoscopic adjustable gastric banding R/O hematoma around band port R/O abscess formation around band port & catheter related infection

HD #2

HD #4

HD #7

Clinical course

ADJUSTABLE GASTRIC LAP-BANDING Topic review ADJUSTABLE GASTRIC LAP-BANDING

Laparoscopic adjustable gastric banding Belachew and colleagues The most frequently performed bariatric procedure Placement of an implantable silicone band around the upper stomach, creating a channel between a small proximal pouch and the distal stomach To restrict intake and result in early satiety

Laparoscopic adjustable gastric banding

LAGB ; Complication Dilatation 3.97% Dislocation of band 1.62% Port rotation/ movement 0.87% Cath. Rupture/ disconnection/leak 0.80% Erosion 0.59% Infection of band and reservoir 0.36% Wound infection 0.28% Bleeding (GI) 0.05% Surgery 2004;135:326-51

F/23 AJR 2005;184:109-112

M/40 OBES SURG 2008;18:1636-39

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