Treatment option in patient presenting with small bowel obstruction from phytobezoar at the jejunojejunal anastomosis after Roux-en-Y gastric bypass.

Bezoar is a rare cause of small bowel obstruction after Roux-en-Y gastric bypass (RYGB). We report the case of a 34-year-old man who developed small bowel obstruction secondary to a phytobezoar at the jejunojejunal anastomosis, 5½ years after the patient underwent RYGB for morbid obesity. The phytobezoar developed in the background of recurring abdominal pain. Imaging studies suggested complete obstruction of the alimentary limb. Laparoscopic exploration demonstrated complete obstruction of the alimentary and biliopancreatic limb. Patient had successful treatment with laparoscopic enterototomy. Six months after the laparoscopic removal of phytobezoar, patient remained asymptomatic. Phytobezoar formation must be considered in the differential diagnosis when postgastric bypass patients present late with obstructive symptoms. We believe that this is the first report of a phytobezoar obstructing at the jejunojejunal anastomosis after RYGB.