EP-664 Remnant of stomach strangulation post Roux-en-y gastric bypass and hiatal hernia repair for obesity

Abstract

Abstract Introduction and Background Herniation of the remnant of the stomach post Roux-en-gastric bypass and hiatal hernia repair is a very rare complication that require high index of suspicion to diagnose and immediate surgical intervention. In the literature, there were reported cases of herniation of gastric pouch and Roux limb but not the remnant of the stomach hence we report this unusual case. Case report A 66-year-old lady was admitted with dysphagia, vomiting, epigastric and retrosternal chest pain. She has had laparoscopic Roux-en-y gastric bypass and hiatal hernia repair 8 years before this admission complicated with recurrence of the hiatal hernia which was repaired one year prior to this presentation. CT scan of the chest and abdomen showed herniation of both the neo-stomach and the gastric remnant up in the posterior mediastinum through the hiatus. Patient consented for repair on the next day however her condition deteriorated over night and was taken to theatre and underwent emergency laparoscopic converted to open resection of strangulated ischemic remnant of stomach and preservation of the gastric pouch and the Roux limb. Conclusion This a very rare and uncommon event following a Roux-en-y gastric bypass and hiatal hernia repair, a prompt diagnosis and early surgical intervention is imperative to avoid catastrophic complications.