Massive Esophageal Dilatation Following Laparoscopic Adjustable Gastric Banding Presenting as Acute Respiratory Distress After Swallowing Effervescent Granules: A Case Report.

Esophageal dilatation is a recognized late complication of laparoscopic adjustable gastric banding (LAGB), resulting from chronic outflow obstruction and esophageal dysmotility. Although most cases are clinically mild, severe dilatation can produce mass effect on adjacent mediastinal structures and rarely cause acute cardiopulmonary compromise. A 63-year-old female with a history of obesity, hypertension, glaucoma, and LAGB placement more than 15 years earlier presented with acute respiratory distress during an upper gastrointestinal contrast study. Shortly after swallowing effervescent granules, she developed abrupt chest pressure, dyspnea, wheezing, cough, nausea, and abdominal bloating. A resuscitation team was activated because of concerns for acute respiratory distress, and she was empirically treated for anaphylaxis with intramuscular epinephrine, corticosteroids, antihistamines, nebulized epinephrine, bronchodilators, and supplemental oxygen. Her symptoms rapidly resolved. However, she had no urticaria, angioedema, hypotension, or persistent bronchospasm. Imaging demonstrated a markedly dilated, gas-filled esophagus measuring up to 75 mm in diameter. Blood gas analysis during the episode demonstrated acute respiratory acidosis with hypercapnia, which subsequently normalized. The patient's acute respiratory distress was attributed to sudden gaseous expansion of a chronically dilated esophagus following administration of effervescent granules, resulting in transient airway compression. This case highlights a rare but potentially life-threatening manifestation of severe esophageal dilatation following LAGB and emphasizes the importance of considering structural causes of acute respiratory distress when the clinical features of anaphylaxis are absent.