Case report Unidentified swallowed object?: when an erosion is not an erosion Karen E. Gibbs, M.D., F.A.C.S. a, *, Gangadasu Reddy, M.D. a , Tracey Straker, M.D., M.P.H. b a Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York b Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York Received October 7, 2009; revised October 8, 2009; accepted October 10, 2009 Gastrointestinal obstructions have been caused by a number of intentionally and accidentally ingested items. We have reviewed the clinical course of the unknown loss of an anesthetic mechanical device extender. Case report A 49-year-old man had undergone uncomplicated Lap- Band placement. His preoperative weight had been 259 lb, with a body mass index of 40 kg/m 2 . His perioperative course was uncomplicated. At 2 months after surgery, the patient presented with a 1-day history of persistent nausea and vomiting. The patient initially reported that he had cheated on his diet and had consumed fried chicken. He reported that subsequent to this meal, he could no longer tolerate liquids or solids. The patient was admitted, and an upper gastrointestinal study was obtained. Abnormal flow of contrast was seen at the level of the band (Fig. 1). The original thought was of a possible leak, because of the irregular flow of contrast at the region of the band. Endos- copy was subsequently performed. The endoscopist re- ported that the evaluation was consistent with band erosion (Fig. 2). When reviewed by the surgeon, erosion seemed unlikely given the previous radiologic findings and the na- ture of the intraluminal object on the endoscopic report. On additional discussion with the patient, he denied any possi- bility of having swallowed a foreign body. Repeat endoscopy was performed, with the surgeon present during the procedure. It was clearly demonstrated that a foreign body was present at the level of the band. Attempts to remove the object were futile, because the foreign body was securely wedged at this location. After multiple attempts to remove the object, the endoscopist pushed the object into the stomach (Fig. 3). It was thought that by pushing the object into the stomach, it might provide for a better orientation and hold on the object to facilitate its removal. However, additional attempts to remove the object using various endoscopic devices were unsuccessful. At this point, we discussed the following options: to take the patient to surgery to remove the object; leave the object in place and attempt removal at another time; or leave the object in place with the expectation that it might pass by itself. The risks, benefits, and alternatives were then dis- cussed with the patient, and he opted to wait. We decided to attempt removal of the object in a few days if it was still in the stomach. Our thought was that time might have allowed resolution of the edema that was present. Three days later, the patient underwent repeat endoscopy, and the object was *Reprint requests: Karen E. Gibbs, M.D., Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467. E-mail: kegibbsmd@aol.com Fig. 1. Contrast study with abnormal contrast flow at level of band. Surgery for Obesity and Related Diseases 6 (2010) 319 –321 1550-7289/10/$ – see front matter © 2010 American Society for Metabolic and Bariatric Surgery. All rights reserved. doi:10.1016/j.soard.2009.10.006