Retrograde intussusception of jejunojejunostomy after Roux-En-Y gastric bypass leading to small bowel obstruction - Case report of a rare and serious complication.

Abstract

Roux-en-Y gastric bypass (RYGB) is the second most common bariatric procedure performed in the United States. Intussusception post RYGB is a very rare complication that usually presents with vague abdominal symptoms and often leads to partial or complete small bowel obstruction. While it usually occurs on average 36 months postoperatively, we present here a case 32 years after open Roux-En-Y gastric bypass. A 63-year-old Caucasian female who underwent an uncomplicated open RYGB 32 years prior presented to the emergency department (ED) with a two-day history of acute-onset, intermittent and severe abdominal pain in the left lower quadrant with radiation to the left flank. Clinical symptoms, physical exam, laboratory, and imaging results revealed retrograde intussusception into the jejunojejunostomy (JJ) with small bowel obstruction. She underwent emergency laparoscopy which was converted to a midline laparotomy. En bloc resection of the JJ was performed with two anastomoses reconstruction. She was successfully discharged home on post-operative day four. Female patients who experience very good weight loss post RYGB are prone to developing retrograde intussusception. The pathophysiology remains unknown but bowel dysmotility from ectopic pacesetters has been implicated. Symptoms are usually nonspecific, and laparoscopy should be attempted in stable patients. Prompt surgical intervention is warranted. Resection of the JJ with re-anastomoses has demonstrated the lowest risk of recurrence. Retrograde intussusception after RYGB is a rare complication with the potential for devastating consequences. Even without a clear lead point on imaging, we recommend a low threshold for surgical intervention. • Retrograde intussusception post RYGB is a very rare complication usually presenting with vague abdominal symptoms. • Female patients who experience very good weight loss post RYGB are most prone. • Operative intervention should not be delayed after appropriate resuscitation. • Resection of the jejunojejunostomy with two anastomoses recreation has least likelihood of recurrence.