Jejunojejunostomy Intussusception After Roux-en-Y Gastric Bypass: Do We Need to Treat?

Abstract

Jejunojejunostomy (J-J) intussusception is a rare complication that occurs in 0.4% of patient after Roux-en-Y gastric bypass (RYGB). Although reduction or resection with revision of the area of intussusception appears to be effective, in less acute patients, the best treatment options are controversial. Here, we present a rare case of jejunojejunostomy intussusception after Roux-en-Y gastric bypass that resolved after single balloon enteroscopy. A 30-year-old female patient presented to our facility with left upper quadrant abdominal pain of few days duration associated with nausea and vomiting. Past history was significant for partial gastrectomy, Roux-en-Y gastric bypass surgery of 10 years duration, and multiple other abdominal surgeries for enterocutanous fistula. On admission, her vitals were stable, and abdominal exam showed soft, non-distended abdomen with tenderness at the left upper quadrant, with no peritoneal signs. Complete blood count, lipase, and lactate were normal. Serum electrolytes were significant for hypokalemia secondary to vomiting. Computed tomography (CT) scan of the abdomen showed J-J intussusception at the Roux-en-Y anastomosis (Image 1). She was scheduled for a single balloon enteroscopy for further evaluation. Endoscopic examination showed no evidence of intussusception or any obstruction of anastomosis sites and limbs. The patient tolerated the procedure well without complications. After the procedure, the patient underwent a follow up CT of abdomen and pelvis that showed no residual intussusception. Although her intussusception might be resolved with air insufflation during the single balloon enteroscopy, spontaneous resolution might be another possibility. On hospital day 3, the patient was tolerating a regular diet and her symptoms completely resolved. Jejunojejunostomy intussusception after Roux-en-Y gastric bypass is uncommon, and might resolve with a single balloon enteroscopy or spontaneously. Watchful waiting could be an appropriate option in less acute cases.Figure: Image 1: IV Contrast enhanced Axial (A) and coronal (B) computed tomography (CT) of the abdomen demonstrating intussusception at the Roux-en-Y anastomosis (red arrow).