Radiology Commentary on Gastric Adjustable Band as a Retained Foreign Object: A Case Report

Retained foreign bodies after surgery are not new phenomena, and it takes an entire (surgical and nonsurgical) team to reduce such occurrences. In this case, no new foreign body was introduced into the patient, and hence was probably not part of the surgical count. There was additional delay in recognizing this device as an unintended foreign body on radiographic imaging.

The radiologist's job is to evaluate all foreign bodies encountered at imaging to determine (1) what the foreign body is and (2) if it is in the appropriate location. In retrospect and realizing that hindsight is more easily 20:20, the device does not look like the contraceptive devices most commonly seen at computed tomography (CT) in the United States. For example, intrauterine contraceptive devices (IUDs) should be located in the uterus and are most commonly T-shaped. Tubal occlusive devices are also encountered at CT fairly frequently and appear as clips or linear structures (Essure; Bayer, Whippany, NJ) within the tubes.

The above device looks somewhat like a pessary, which is a round object placed in the vagina to help alleviate pelvic organ prolapse. If the device were a pessary, it would be malpositioned, as it is located too high in the pelvis to be in the vagina, with hindsight again being closer to 20:20. A photograph of an extracted gastic band is provided in Figure 1.

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FIG. 1.

A typical extracted Lap-Band^TM (Allergan, Irvine, CA).

When the radiologist is not sure what a device is and the patient's medical record offers no help, the radiologist should describe the device in detail and probably ask the ordering physician to (the dreaded words) “correlate clinically.”

Perhaps as the culture in medicine shifts to providing more patients with their imaging study reports whether through patient portals or printing out the report and handing it to the patient, these sorts of errors can be avoided. Hopefully, a patient who reads a report describing a 3.5 cm (rough estimate) circular structure in the pelvis that looks like an “appropriately positioned contraceptive device” would speak up and say that she does not have such a device.