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Three women aged 32, 35 and 37 years, respectively, presented with upper abdominal symptoms such as pain, nausea and vomiting. Their history revealed that an adjustable silicone gastric band had been implanted for the treatment of obesity one, four and seven years previously. Their symptoms were not immediately recognised as being possible complications of the gastric band and this caused treatment delay. In the first two patients ischaemic lesions were found at laparotomy. Their surgical treatment was successful. The third patient, however, was referred to the surgeon who had placed the gastric band, but she died in the mean time. Lack of recognition of symptoms caused by gastric banding and delay in diagnostic and therapeutic intervention may lead to very serious complications, or even death. Good diagnostic imaging and prompt therapeutic intervention can prevent the progression from herniation of the stomach through the silicone gastric band to irreversible ischaemia and eventually necrosis and perforation.

A 66-year-old man with Child-B alcoholic cirrhosis presented with melaena due to hemorrhagic gastritis. Clinical examination revealed cyanosis and clubbing accompanied by severe hypoxaemia without signs of obstructive or restrictive lung disease. Contrast-enhanced echocardiography showed right to left shunt due to intrapulmonary shunting leading to the diagnosis of hepatopulmonary syndrome. Hypoxaemia in patients suffering from chronic liver disease can have different causes but in the presence of cyanosis and clubbing without signs of lung disease the hepatopulmonary syndrome should be suspected. When presence of intrapulmonary shunts has been proven by contrast-enhanced echocardiography, a 100% oxygen test can determine the need for pulmonary angiography and thus determine the indication for interventional therapy or liver transplantation. The patient described was treated supportively with long-term oxygen therapy 6 l/min. Three months later his clinical condition was stable. An attempt to reduce the need for nasal oxygen failed.