Antiperistaltic (retrograde) intussusception after laparoscopic Roux-en- Y gastric bypass procedure

Abstract

R F t Small bowel obstructions are a well-recognized compliation after Roux-en-Y gastric bypass. Rarely, small bowel ntussusception causes the obstruction [1–13]. The prevailng hypothesis is that postoperative alterations in small bowel otility lead to this unusual complication [1,3,4,7–9]. A 46-year-old woman had undergone laparoscopic, retocolic, retrogastric Roux-en-Y gastric bypass 5 years beore presentation. Her body mass index had decreased from 5 to 26 kg/m. She presented with 8 hours of periumbilical bdominal pain, nausea, and bilious emesis. The physical xamination revealed a distended, tympanitic abdomen with yperactive bowel sounds and mild diffuse tenderness to alpation. Radiographs demonstrated dilated small bowel nd an abnormal soft-tissue density in the mid-abdomen Fig. 1). Contrast-enhanced computed tomography showed small bowel obstruction distal to the jejunojejunal anasomosis with intussusception (Fig. 2). Laparotomy revealed a retrograde intussusception startng 30-cm beyond the jejunojejunal anastomosis (Fig. 3). he common alimentary limb was also herniated through a ransverse mesocolon defect, although no obstruction was resent at this level. The intussusceptum (comprised of ommon channel) was manually reduced. Given the unclear tiology of the obstruction, the intussusceptum was reected. The mesocolonic hernia was reduced, and the meocolic and small bowel mesenteric defects were closed. athologic examination demonstrated mucosal necrosis and dema but no discrete lead point.