A rare case of internal hernia, intussusception and volvulus following gastric bypass: A case report and literature review. (2020)

• Record Type: Journal Article
• Authors: Elkbuli, Adel; Santarone, Kristen; Kinslow, Kyle; McKenney, Mark; Boneva, Dessy
• Is Part Of: International journal of surgery case reports. Volume 67(2020)
• Page Start: 178
• Page End: 182
• Publication Date: 2020
• Subjects: CT computed tomography -- RYGB roux-en-y gastric bypass -- JJ jejuno-jejunal -- ICU intensive care unit -- SBO small bowel obstruction; Gastric bypass -- Intussusception -- Internal hernia -- Volvulus -- Bariatric surgery -- Surgical outcomes; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2020.01.060
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Development of a triad of intussusception, volvulus, and internal hernia after RYGB surgery is rare. In patients with history of RYGB and acute abdomen, high suspicion for obstructive complications is required to allow for timely diagnosis and early surgical intervention. Early surgical intervention of SBO secondary to RYGB was sufficient for preventing bowel necrosis and subsequent bowel resection. Abstract: Introduction: The Roux-en-y gastric bypass (RYGB) surgery is one of the most common and successful weight loss procedures. Procedure mortality is low, but intestinal complications account for a high percentage of associated morbidity. Internal hernias remain one of the most common complications while volvulus and intussusception are rare. Presentation of case: A 22-year-old woman with a past surgical history of laparoscopic RYGB six years prior presented with a 12 -h history of abdominal pain. Exploratory laparotomy revealed concomitant volvulus, internal hernia and intussusception at the J-J anastomosis which was reduced without need for bowel resection. Her post-operative course was unremarkable and she was discharged home five days later. Discussion: Many previous cases of intussusception related to RYGB surgery have required treatment with bowel resection secondary to delayed surgical intervention. Due to high variability in clinical presentation of post-RYGB obstruction, a high index of suspicion is necessary for prompt recognition. Early surgical intervention may prevent the need for bowel resection and improve patient outcomes. Conclusion: This case represents an unusual complication of RYGB involving intussusception, internal hernia and volvulus that was successfully managed without need for bowel resection due to early identification and surgical intervention.