A rare case of proximal closed loop obstruction between gastric band and obstructed ventral hernia

A 68-year-old woman with severe obesity presented with abdominal pain, nausea, and dehydration. She had a history of laparoscopic adjustable gastric banding (LAGB). Examination revealed tachycardia, hypotension, a chronic ventral hernia with mild tenderness, no peritonitis, and slight abdominal distension. A computed tomography (CT) scan showed massive gastric and dilation and obstruction at the level of gastro-esophageal junction (Band), proximal small bowel loop dilation, distal bowel collapse, and a ventral hernia involving high-grade obstruction and ischemic bowel. Exploratory laparotomy revealed a "closed-loop" obstruction between the gastric band and hernia. Her stomach was dilated and obstructed at the gastroesophageal junction, and ischemia affected 70 cm of the intestine in the hernia sac. This case emphasizes that patients with LAGB may be unable to vomit, and therefore a closed-loop obstruction should not be overlooked even without vomiting. Early diagnosis and timely treatment led to a favorable outcome.