TH6.10 Rare case of concurrent caecal volvulus and internal herniation through the mesenteric defect following a Roux en Y gastric bypass - Case report and review of the literature

Abstract

Abstract Introduction Roux En Y gastric bypass [RYGB] remains the most effective bariatric surgical option to date. Unfortunately, the anatomic alterations caused by the surgery can predispose towards the very rare occurrence of internal herniation through the mesocolic defect created if a retro colic approach is used. Case presentation We report a patient who underwent laparoscopic roux en y gastric bypass 3 years ago who presented to our surgical unit with acute abdominal pain and obstipation. On exploratory laparotomy, we noted internal herniation of the entire small bowel and caecum through the mesenteric defect with concomitant volvulus of the caecum around its axis. Fortunately, the bowel was viable after detorsion and after reduction, the mesenteric defect was repaired. Conclusion Although internal herniation of the small bowel through the trans mesenteric defect following RYGB has been reported, we believe ours is the first report of caecal and ascending colonic herniation. Secondly, we believe our case is unique in that there was concomitant caecal volvulus in addition to herniation through the trans mesenteric defect. A careful search of the literature did not reveal any similar cases with concurrent internal herniation and volvulus of the right colon following RYGB. Internal herniation and volvulus of the right colon may rarely occur following RYGB. Symptoms may be nonspecific and classic features of small bowel obstruction such as vomiting and abdominal distension may not be seen. Imaging may be nonspecific. A high index of suspicion and early intervention is essential to prevent morbidity and mortality.