Malrotation—an unexpected finding at laparoscopic Roux-en- Y gastric bypass: a video case report

Abstract

A 38-year-old woman with a long history of severe besity and a body mass index of 48 kg/m elected to undergo LRYGB. She had a medical history of pulmonary embolism and laparoscopic cholecystectomy for symptomatic cholelithiasis. She did not undergo any preoperative abdominal radiological studies, and no mention had been made of abnormalities at her laparoscopic cholecystectomy. After placement of the umbilical camera trocar, the initial inspection of the abdominal cavity revealed what appeared to be a mobile cecum and easily visualized appendix (see video). On retrospect, this should have alerted us to the possibility of midgut malrotation. Additional trocars were placed (Fig. 1), and the gastric pouch was created. The omentum was then grasped in an attempt to elevate the omentum and transverse colon cephalad. At first, it was thought that adhesions were tethering the transverse colon, but we then realized that the entire