When the Brakes Came Off: Re-feeding Oedema after Deflation of a Gastric Band: A Case Report
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CASE REPORT
When the Brakes Came Off: Re-feeding Oedema after Deflation of a Gastric Band: A Case Report Royce P. Vincent & Simon J. B. Aylwin & Carel W. le Roux
Received: 24 February 2009 / Accepted: 30 July 2009 / Published online: 13 August 2009 # Springer Science + Business Media, LLC 2009
Abstract Bariatric surgery is now the treatment of choice for morbid obesity, but is not without risk. Patients are cared for in specialised centres, but complications can present to nonspecialised centres. We describe life-threatening re-feeding oedema in a patient following routine deflation of a gastric band. Band deflation or removal may be required for various reasons, but rapid release of the band without additional supplementation of electrolytes may be dangerous due to re-feeding syndrome. Keywords Bariatric surgery . Gastric banding . Re-feeding oedema
Introduction Bariatric surgery currently represents the treatment of choice for morbid obesity. Most surgical procedures are carried out in low-risk individuals and the perioperative morbidity and mortality rates are low [1]. However, as clinical experience expands the spectrum of long-term complications is becoming evident, nutritional disorders such as protein-calorie malabsorption [2], vitamin and trace element deficiencies [3] and post-prandial hypoglycaemia R. P. Vincent : C. W. le Roux (*) Department of Chemical Pathology, King’s College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK e-mail: [email protected] S. J. B. Aylwin Department of Endocrinology, King’s College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
[4] are increasingly recognised. In this report, we describe a patient who developed a nutrition-related disorder—re-feeding oedema—following routine deflation of a gastric band.
Case Report A 23-year-old female weighing 120 kg (body mass index (BMI) of 41 kg/m2) underwent laparoscopic adjustable gastric banding primarily for reasons of body image dysphoria. She had no history of an eating disorder prior to gastric banding. Over the subsequent 12 months, she experienced reduced appetite and restriction to food ingestion due to the band and lost 75 kg to a nadir weight of 56 kg (BMI 19 kg/m2). After weight loss, she developed bulimic behaviour with binge eating and deliberate purging. During this time, her menstrual periods became infrequent. Two years after the procedure, in view of the excessive weight loss and maladaptive behaviour, she opted to have the band fully deflated. Following the deflation, her appetite and food intake increased rapidly and she was able to eat without any restriction. Five days later, she presented to the emergency department having gained 12 kg in weight, with bilateral leg swelling and lower back pain. Examination revealed severe bilateral pitting oedema of her legs extending to the abdomen and upper limbs. Biochemical analysis on admission revealed marked hypophosphataemia with a serum phosphate of 0.29 mmol/L (normal 0.8– 1.4 mmol/L), an albumin of 34 g/L (35–50 g/L), deranged l
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