Small bowel obstruction due to retrograde intussusception after laparoscopic Roux-en-Y gastric bypass.

A 39-year-old female presented 4 years after laparoscopic Roux-en-Y gastric bypass with colicky abdominal pain, vomiting and inability to pass flatus. She had lost 100% of her excess weight after surgery and her body mass index had dropped from 46 to 22 kg/m(2). At exploration, a retrograde intussusception of the small bowel was noted distally to the jejunojejunostomy causing obstruction of the alimentary and biliopancreatic limb and gastric remnant. The intussusception was irreducible with signs of bowel ischaemia and required excision. The patient made an uneventful recovery. Colicky abdominal pain in a bariatric patient persisting more than 4 h mandates urgent investigation with abdominal computed tomography. Emergency care doctors should be aware of this specific complication in bariatric patients and seek expert advice.