Acute esophageal dilation mimicking serious pulmonary complication after post-bariatric abdominoplasty

Abdominoplasty is a frequent operative procedure among patients with massive weight loss following laparoscopic adjustable gastric banding (LAGB) surgery. After abdominoplasty, patients are carefully monitored and usually discharged from the clinic after overnight hospitalization. We report a case of acute esophageal dilation after abdominoplasty, following LAGB, mimicking a serious pulmonary complication. Three hours after a complete uneventful abdominoplasty, including reinforcement of the abdominal wall and removal of apron skin, a 39-year-old female patient developed cough and signs of respiratory distress. These symptoms were successfully treated by ventolin (salbutamol) inhalation. During the first night the patient required additional inhalation and was discharged from the hospital in good and stable condition. Three hours later she noticed respiratory distress and fever and was referred to the emergency room (ER). In the ER, a pulmonary embolism was suspected and the patient underwent CT angiography. On examination, acute severe esophageal dilation with fluid level was found. The esophageal diameter was 47 mm and the esophagus was compressing the mediastinum and trachea. The acute esophageal dilation was resolved after the gastric band was released by evacuation of saline solution from the subcutaneous port. The above-mentioned symptoms quickly disappeared during the next 2 h and the patient was discharged from the ER. We suggest complete gastric band release as a standard component of a bariatric surgery patient's preparation for abdominoplasty surgery. Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.