Abstract
IntroductionThe Roux-en-y gastric bypass (RYGB) surgery is one of the most common and successful weight loss procedures. Procedure mortality is low, but intestinal complications account for a high percentage of associated morbidity. Internal hernias remain one of the most common complications while volvulus and intussusception are rare. Presentation of caseA 22-year-old woman with a past surgical history of laparoscopic RYGB six years prior presented with a 12 -h history of abdominal pain. Exploratory laparotomy revealed concomitant volvulus, internal hernia and intussusception at the J-J anastomosis which was reduced without need for bowel resection. Her post-operative course was unremarkable and she was discharged home five days later. DiscussionMany previous cases of intussusception related to RYGB surgery have required treatment with bowel resection secondary to delayed surgical intervention. Due to high variability in clinical presentation of post-RYGB obstruction, a high index of suspicion is necessary for prompt recognition. Early surgical intervention may prevent the need for bowel resection and improve patient outcomes. ConclusionThis case represents an unusual complication of RYGB involving intussusception, internal hernia and volvulus that was successfully managed without need for bowel resection due to early identification and surgical intervention.
Highlights
The Roux-en-y gastric bypass (RYGB) surgery is one of the most common and successful weight loss procedures
Roux-en-y gastric bypass (RYGB) remains the gold standard for bariatric surgery due to providing safe and sustainable weight loss compared to other operations such as sleeve gastrectomy, gastric banding or biliopancreatic diversion/duodenal switch [1,2,3,4]
We present a rare case of a woman who developed a triad of post-RYGB volvulus, internal hernia and intussusception that was successfully managed via emergent exploratory laparotomy without need for bowel resection
Summary
The Roux-en-y gastric bypass (RYGB) surgery is one of the most common and successful weight loss procedures. Internal hernias remain one of the most common complications while volvulus and intussusception are rare. Exploratory laparotomy revealed concomitant volvulus, internal hernia and intussusception at the J-J anastomosis which was reduced without need for bowel resection. Her post-operative course was unremarkable and she was discharged home five days later. DISCUSSION: Many previous cases of intussusception related to RYGB surgery have required treatment with bowel resection secondary to delayed surgical intervention. Surgical intervention may prevent the need for bowel resection and improve patient outcomes. CONCLUSION: This case represents an unusual complication of RYGB involving intussusception, internal hernia and volvulus that was successfully managed without need for bowel resection due to early identification and surgical intervention
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