Lessons from recent medical history: an obsolete anti-reflux device in an older patient with variable gastrointestinal symptoms

A frail 93-year-old lady presented with delirium, on a background of heart failure, cerebrovascular disease, constipation and osteoporosis. A computed tomography (CT) pulmonary angiography, undertaken due to persistent hypoxia, identified no pathology aside from an unusual appearance of the left hypochondrium, necessitating further elucidation with CT abdomen. This unexpectedly reported the presence of a gastric band, leading us to consider possible misidentification. Perusing her General Practitioner (GP) records demonstrated that she underwent surgical insertion of an Angelchik prosthesis in 1984. Angelchik prostheses were anti-reflux devices used for a short period, before falling from favour due to increasing evidence around late developing complications. A collateral history from family revealed that this patient had experienced multiple longstanding symptoms including bloating, reflux and constipation, potentially linked to her prosthesis, a previously unestablished link.