Arnaldo Machado1, Manuel Carvalho2, Jorge Caravana2. 1. General Surgery Service, Hospital do Espírito Santo E.P.E., Évora, Portugal. Electronic address: arnaldo3machado@gmail.com. 2. General Surgery Service, Hospital do Espírito Santo E.P.E., Évora, Portugal.
Abstract
INTRODUCTION: Roux-en-Y gastric bypass (RYGB) has been the most common surgical operation used to treat obesity and its inherent co-morbidities. Intussusception with bowel obstruction after RYGB is a rare complication and its physiopathology remains unclear. The diagnosis is generally based on typical image of computed tomography (CT) scan and a surgical exploration is generally recommended. CASE PRESENTATION: A 54-year-old female patient with history of a gastric bypass six years before, presented herself on the emergency department with acute onset of abdominal pain, nausea, and nonbilious vomiting. Her vital signs were stable. On abdominal evaluation a mass in the left flank was identified. The CT scan showed a small bowel intussusception. MANAGEMENT: Laparoscopic surgical exploration was performed and the diagnosis confirmed: retrograde jejunojejunal intussusception without vascular impairment. Reduction of the intussusception was possible without the need for bowel resection. A laparoscopic "second look" was made on the following day, revealing no signs of ischemia. There were no postoperative complications and the patient was discharged home on postoperative day 8. DISCUSSION: Intussusception after a RYGB is rare and the diagnosis is generally based on CT scan exam. Surgical exploration should be performed as soon as possible to prevent bowel ischemia and the need for resection.
INTRODUCTION: Roux-en-Y gastric bypass (RYGB) has been the most common surgical operation used to treat obesity and its inherent co-morbidities. Intussusception with bowel obstruction after RYGB is a rare complication and its physiopathology remains unclear. The diagnosis is generally based on typical image of computed tomography (CT) scan and a surgical exploration is generally recommended. CASE PRESENTATION: A 54-year-old female patient with history of a gastric bypass six years before, presented herself on the emergency department with acute onset of abdominal pain, nausea, and nonbilious vomiting. Her vital signs were stable. On abdominal evaluation a mass in the left flank was identified. The CT scan showed a small bowel intussusception. MANAGEMENT: Laparoscopic surgical exploration was performed and the diagnosis confirmed: retrograde jejunojejunal intussusception without vascular impairment. Reduction of the intussusception was possible without the need for bowel resection. A laparoscopic "second look" was made on the following day, revealing no signs of ischemia. There were no postoperative complications and the patient was discharged home on postoperative day 8. DISCUSSION: Intussusception after a RYGB is rare and the diagnosis is generally based on CT scan exam. Surgical exploration should be performed as soon as possible to prevent bowel ischemia and the need for resection.