Near Complete Biliopancreatic Segment Necrosis: A Rare and Unknown Entity Observed After Roux-en-Y Gastric Bypass-A Case Report.

Abstract

Roux-en-Y gastric bypass is one of the common bariatric surgery procedures performed worldwide. Necrosis of the biliopancreatic or Roux limbs in the late period after RYGB is a rarely observed condition, the most common causes of which are postoperative adhesion, inflammatory entities, volvulus, intussusception, and internal herniations. The goal of surgical treatment is the removal of the necrotic segment and the reconstruction of biliopancreatic or gastric drainage. Here, we present a rare case in which a patient developed complete necrosis of the third and fourth segments of the duodenum and proximal jejunal limb in the postoperative seventh month after undergoing Roux-en-Y gastric bypass surgery. Necrosis occurring after RYGB surgery often affects the Roux limb, though necrosis of the biliopancreatic limb is extremely rare. The goal of surgery is to remove the necrotic segment and reconstruct the drainage. An area of ischemia is often observed in the jejunum, while a large ischemic area was noted in the present case that encompassed the third and fourth parts of the duodenum. Although in general necrosis of the Roux limb occurs due to volvulus, intussusception, or internal herniation following RYGB surgery, it must be taken into account that necrosis of the jejunal, duodenal, or complete biliopancreatic segment may occur in cases in which the underlying etiology cannot be exactly revealed.