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Unique long-term simultaneous complications of conventional Roux-en-Y gastric bypass after 27 years: A case report. Int J Surg Case Rep 2022; 101:107787. [PMID: 36434869 PMCID: PMC9685287 DOI: 10.1016/j.ijscr.2022.107787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/09/2022] [Accepted: 11/19/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION We report a case of late concomitant complications caused by conventional Roux-en-Y gastric bypaas and its managements. PRESENTATION OF CASE A 62-year-old male presented 27 years after conventional gastric bypass Y-de-Roux (BGYR) with, sudden, moderate intensity abdominal pain, nausea, biliary vomiting and hyporexia. Persistent abdominal pain was constant, so a thoracoabdominal tomography was requested by the surgeon. It confirmed the presence of intestinal intussusception associated with lithiasis and cholecystitis. The patient reported having lost 45 kg since the BGYR. He goes to the operating room for definitive management. DISCUSSION The etiology of post-BGYR intussusception is largely unknown, and multiple hypotheses have been created, such as the iatrogenic stitch created by the suture line in the entero-enteric anastomosis and the most common pattern found is antegrade. The use of contrasted CT as the most reliable diagnostic method. CONCLUSION The importance of taking into account the possible complications existing in bariatric patients and their frequency gives us the opportunity to suspect and detect them in time and in the most cases the management must be surgical.
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Diab ARF, Oviedo RJ, Nazir S, Sujka JA, DuCoin CG. RYGB-Induced Gut Dysmotility and Retrograde Intussusception: an Unusual Phenomenon. A Narrative Literature Review. Obes Surg 2022; 32:3452-3457. [PMID: 35947330 DOI: 10.1007/s11695-022-06236-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/27/2022] [Accepted: 08/04/2022] [Indexed: 11/25/2022]
Abstract
Intussusception following Roux-en-Y gastric bypass (RYGB) is a rare complication of bariatric surgery with an unclear etiology. The pathogenesis underlying intussusception after gastric bypass is likely different from that in the general population. Post-RYGB intussusception might be related to motility issues in the divided small bowel, thinning of the mesentery following rapid weight loss, or anastomotic sutures/staple line acting as the lead point. This condition can cause obstruction with subsequent strangulation and bowel necrosis if not recognized and treated promptly. Clinical presentation is vague and nonspecific, and computerized tomography scan represents the diagnostic test of choice. Surgical treatment consists of reduction with or without anastomosis resection and reconstruction. This literature review provides an extensive overview of this condition, based on multiple studies involving 120 patients.
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Affiliation(s)
- Abdul-Rahman F Diab
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida, Morsani College of Medicine, 5 Tampa General Circle, Tampa, FL, 33606, USA.
| | - Rodolfo J Oviedo
- Department of Surgery, Houston Methodist, 6550 Fannin St., Houston, TX, 77030, USA
| | - Sharique Nazir
- Department of Surgery, NYU Grossman School of Medicine, 8714 Fifth Avenue, Brooklyn, NY, 11209, USA
| | - Joseph A Sujka
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida, Morsani College of Medicine, 5 Tampa General Circle, Tampa, FL, 33606, USA
| | - Christopher G DuCoin
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida, Morsani College of Medicine, 5 Tampa General Circle, Tampa, FL, 33606, USA
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3
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Oor JE, Goense L, Wiezer MJ, Derksen WJM. Incidence and treatment of intussusception following Roux-en-Y gastric bypass: a systematic review and meta-analysis. Surg Obes Relat Dis 2021; 17:1017-1028. [PMID: 33632616 DOI: 10.1016/j.soard.2021.01.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 12/08/2020] [Accepted: 01/11/2021] [Indexed: 11/15/2022]
Abstract
Intussusception is a rare yet potentially life-threatening complication following Roux-en-Y gastric bypass (RYGB). Multiple case reports have described this complication, and recently, several retrospective studies have been published describing the surgical treatment of intussusception. The aim of this study was to determine the incidence of intussusception following RYGB and provide insight into outcomes of subsequent operative treatment. A systematic search was performed using the PubMed and Cochrane databases. Article selection was performed using the preferred reporting items for systematic reviews and meta-analyses criteria, and selecting articles describing the incidence of intussusception following RYGB. Data was pooled only when 3 or more comparable studies reported on the same outcome. The incidence of intussusception and outcomes of subsequent treatment were analyzed. Furthermore, all published case reports describing intussusception following RYGB were analyzed. A total of 74 studies published between 1991 and 2020 were included, describing 191 patients who underwent RYGB and developed intussusception. We retrieved 68 case reports, including 84 patients, and 6 retrospective studies describing outcomes of surgical treatment in 107 patients, which were used to pool data. There was a predominance of females among the included patients (85%-98%), and patients had significant weight loss following RYGB. The pooled incidence of intussusception following RYGB was .64%. Resection of the affected segment was performed in 34% of the patients. A pooled recurrence rate of 22% was found during follow-up. Resection and reconstruction of the jejunojejunostomy appears to be associated with the lowest risk of recurrence and acceptable complication rates. The pooled incidence of intussusception following RYGB is 0.64%. Typically, patients are female with significant weight loss after RYGB. Symptoms include abdominal pain, nausea, and vomiting. Diagnosis is based on clinical findings and computed tomography scans, warranting early surgical exploration due to the high risk for ischemia. Resection of the jejunojejunostomy appears to be associated with the lowest recurrence rates and acceptable complication rates.
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Affiliation(s)
- Jelmer E Oor
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
| | - Lucas Goense
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Marinus J Wiezer
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Wouter J M Derksen
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
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Poliakin LA, Sundaresan N, Hui B, McKillop IH, Thompson K, Gersin K, Kuwada T, Nimeri A. S146—Jejunojejunal intussusception after roux-En-Y gastric bypass: a case series of 34 patients. Surg Endosc 2020; 35:4632-4637. [DOI: 10.1007/s00464-020-07889-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 08/05/2020] [Indexed: 11/29/2022]
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5
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Stadsvold B, Mckenzie J, Hilton LR, Bolduc A. Retrograde Intussusception after Roux-en-Y Gastric Bypass. Am Surg 2020. [DOI: 10.1177/000313481908500922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
| | - Jaine Mckenzie
- Department of Surgery Medical College of Georgia Augusta University Augusta, Georgia
| | - L. Renee Hilton
- Department of Surgery Medical College of Georgia Augusta University Augusta, Georgia
| | - Aaron Bolduc
- Department of Surgery Medical College of Georgia Augusta University Augusta, Georgia
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6
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Michiels S, Delier C, Philippart P. Anterograde jejunojejunal intussusception through the distal anastomosis as complication after Roux-en-Y gastric bypass. Acta Chir Belg 2019; 119:400-403. [PMID: 29879867 DOI: 10.1080/00015458.2018.1479023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Introduction: Small bowel intussusception is a rare complication after Roux-en-Y gastric bypass (RYGB) whose incidence tends to increase. This rising could be explained by an increasing bariatric surgery over the last two decades and by a better recognition of this potential complication. Patient and methods: We report a case of jejunojejunal intussusception in 33-year-old woman 2 years following a laparoscopic RYGB. She was taken to the operating room for exploratory laparotomy. Results: Its diagnosis is based on a combination of physical, radiological, and operative findings. The surgical exploration confirmed an anterograde jejunojejunal intussusception through the Roux-en-Y anastomosis. A lead point was not identified. We performed the resection of the blind extremity of the biliopancreatic limb to prevent recurrence. Conclusions: Small bowel intussusception is a rare long-term complication after RYGB. The underlying causative mechanism remains unclear. This rare condition may cause obstruction and lead to bowel necrosis if not recognized and treated promptly.
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Affiliation(s)
- Sebastien Michiels
- Department of Surgery, Hospital Epicura Ath, Université Libre de Bruxelles, Belgium
| | - Caroline Delier
- Department of Surgery, Hospital Epicura Ath, Université Libre de Bruxelles, Belgium
| | - Patrick Philippart
- Department of Surgery, Hospital Epicura Ath, Université Libre de Bruxelles, Belgium
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7
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S054: incidence and management of jejunojejunal intussusception after Roux-en-Y gastric bypass: a large case series. Surg Endosc 2019; 34:2204-2210. [DOI: 10.1007/s00464-019-07009-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/19/2019] [Indexed: 02/02/2023]
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8
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Cardaci MB, Keuleneer RD, Massaarani F. Hiatal hernia containing the alimentary limb and the gastric pouch: a rare cause of small bowel obstruction after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2017; 13:1929-1931. [PMID: 28939400 DOI: 10.1016/j.soard.2017.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 08/17/2017] [Accepted: 08/19/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Miguel Bouzas Cardaci
- Department of Abdominal Surgery, Regional Hospital of Val de Sambre, Verviers, Belgium.
| | - Robert De Keuleneer
- Department of Abdominal Surgery, Regional Hospital of Val de Sambre, Verviers, Belgium
| | - Fadi Massaarani
- Department of Abdominal Surgery, Regional Hospital of Val de Sambre, Verviers, Belgium
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9
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Intussusception Involving the Roux-en-Y limb Following Gastric Bypass. J Gastrointest Surg 2017; 21:415-416. [PMID: 27492353 DOI: 10.1007/s11605-016-3224-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 07/22/2016] [Indexed: 01/31/2023]
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10
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Jenkins M, Chui P, Parikh M. Laparoscopic Treatment of Intussusception after Roux-en-Y Gastric Bypass. Surg Obes Relat Dis 2017; 13:364-365. [DOI: 10.1016/j.soard.2016.09.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/24/2016] [Accepted: 09/26/2016] [Indexed: 11/27/2022]
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Khan SJ, Desmarais AM, Joseph B, Amini R. A Rare Case of Adult Onset Intussusception Complicated By Narcotic Dependence. Cureus 2017; 9:e964. [PMID: 28191368 PMCID: PMC5298909 DOI: 10.7759/cureus.964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This report describes a rare case of adult intussusception in a patient with a history of a Roux-en-Y gastric bypass procedure; complicated by a history of narcotic abuse, methadone dependence, and methamphetamine abuse. Adult patients who have undergone a Roux-en-Y gastric bypass procedure may be at an increased risk of developing intussusception, and clinicians involved in their care should be aware of this potential complication.
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12
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Fringeli Y, Metzger A, Ruzza C, Peters J. [Late complication after Roux-en-Y gastric bypass: Unusual finding]. Chirurg 2014; 86:603-5. [PMID: 25056563 DOI: 10.1007/s00104-014-2828-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Y Fringeli
- Allgemeinchirurgie, Spitalzentrum Oberwallis, Pflanzettastr. 8, 3930, Visp, Schweiz,
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13
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Varban OA, Ardestani A, Azagury DE, Kis B, Brooks DC, Tavakkoli A. Contemporary management of adult intussusception: who needs a resection? World J Surg 2014; 37:1872-7. [PMID: 23571865 DOI: 10.1007/s00268-013-2036-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Surgical resection is often recommended in adults with intestinal intussusception (AI) because of its potential association with malignancy. We provide a contemporary algorithm for managing AI by focusing on the probability of discovering a lead point. METHODS This is a retrospective study of adult patients with computed tomography (CT)-confirmed intussusception who underwent operative management of AI between 1996 and 2011 at a single academic institution. RESULTS Sixty-four patients were diagnosed with AI by CT scan and then managed operatively. The incidence of colonic (CI), small bowel (SBI), and retrograde intussusception (RI) was 14, 55, and 31 %, respectively. All patients with CI had a lead point, whereas none were found among patients with RI. Some 46 % of patients with SBI had a lead point. The probability of discovering a lead point in SBI was increased by past history of malignancy (RR, 3.7, p < 0.001), a mass seen on preoperative CT scan (RR, 2.9, p = 0.005), and age over 60 years (RR, 2.2, p = 0.07). CONCLUSIONS A pathologic lead point is likely with CI but not with RI. Patients with SBI who are over the age of 60 years and have a history of malignancy or a mass noted on CT scan have a higher likelihood of harboring a pathologic lead point.
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Affiliation(s)
- Oliver A Varban
- Department of General Surgery, University of Michigan Health System, 2210 Taubman Center, 1500 E Medical Center Drive, Ann Arbor, MI 48109-5343, USA.
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14
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Varban O, Ardestani A, Azagury D, Lautz DB, Vernon AH, Robinson MK, Tavakkoli A. Resection or reduction? The dilemma of managing retrograde intussusception after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2013; 9:725-30. [DOI: 10.1016/j.soard.2012.05.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 05/04/2012] [Accepted: 05/08/2012] [Indexed: 11/28/2022]
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15
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Intussusception with complete twisting of mesenteric root after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2013; 9:e82-3. [DOI: 10.1016/j.soard.2013.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 02/10/2013] [Accepted: 02/11/2013] [Indexed: 11/22/2022]
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16
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Ng M, Toribio R, Sugiyama G. Rare case of concurrent intussusception and volvulus after Roux-en-Y gastric bypass for morbid obesity. J Surg Case Rep 2013; 2013:rjs018. [PMID: 24963927 PMCID: PMC3579529 DOI: 10.1093/jscr/rjs018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Gastric bypass patients are at risk for small-bowel obstruction secondary to adhesions, internal hernias, intussusception and volvulus. Most gastric bypass patients do not present with classic obstructive symptoms. We present a rare case of concurrent intussusception and volvulus in a woman with previous history of internal hernia following laparoscopic Roux-en-Y gastric bypass surgery.
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Affiliation(s)
- Marilyn Ng
- SUNY-Downstate Medical Center, Brooklyn, NY, USA
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17
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Kartiko S, Ortiz J, Hashemi N, Miick R, Dallal R. Acute liver failure complicating jejunojejunal intussusception presentation in a gastric bypass patient. World J Hepatol 2012; 4:311-3. [PMID: 23293717 PMCID: PMC3536838 DOI: 10.4254/wjh.v4.i11.311] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Revised: 10/26/2012] [Accepted: 11/02/2012] [Indexed: 02/06/2023] Open
Abstract
Over 200 000 weight loss procedures are performed annually in the United States. Physicians must therefore be cognizant of the unique array of complications associated with these procedures. We describe a case of jejunojejunal intussusception in a gastric bypass patient who presented with acute liver failure (ALF) due to acetaminophen (APAP) toxicity. Our patient is a 29 year-old female who had undergone Roux-en-Y gastric bypass surgery seven years prior. She was evaluated in the emergency department for confusion. Her family reported a 3-wk history of progressive abdominal pain and vomiting, for which she had ingested 40 acetaminophen/oxycodone tablets over the past 2 d. Physical examination showed icteric sclerae, a distended abdomen, and grade I encephalopathy. She fulfilled the criteria for ALF and was listed for liver transplantation. Abdominal computed tomography scan revealed a jejunojejunal intussusception. She underwent emergent exploratory laparotomy and resection of the infarcted intussusceptum and the previous jejunojejunostomy. She had rapid clinical improvement, with decreasing liver enzymes and improved hepatic synthetic function. She had complete resolution of coagulopathy and encephalopathy, and was removed from the liver transplant list. She was discharged home 20 d after hospitalization with normal liver tests. This case demonstrates that acute abdominal catastrophes can potentiate liver injury in the setting of acetaminophen toxicity. Encephalopathy may obscure history and physical exam findings. This case also exemplifies the pitfalls in the management of the bariatric surgery patient and the importance of multispecialty collaboration in patients presenting with organ failure.
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Affiliation(s)
- Susan Kartiko
- Susan Kartiko, Jorge Ortiz, Ramsey Dallal, Department of Surgery, Albert Einstein Medical Center, Philadelphia, PA 19030, United States
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18
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Rose M, Richards WO. Laparoscopic Longitudinal Jejunectomy for Intussusception after Gastric Bypass. Am Surg 2012. [DOI: 10.1177/000313481207800602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Melanie Rose
- Department of Surgery University of South Alabama Mobile, Alabama
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19
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Intussusception in adults: what radiologists should know. Emerg Radiol 2011; 19:89-101. [PMID: 22200965 DOI: 10.1007/s10140-011-1006-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Accepted: 11/22/2011] [Indexed: 12/14/2022]
Abstract
Adult intussusception (AI) is a rare entity with an organic lesion within the intussusception in 70-90% of the cases. Intussusception is classified according to location, etiology, and to the presence or not of a lead point. We illustrate several causes of AI with a variety of radiological findings on plain film, ultrasonography, computed tomography, magnetic resonance, and endoscopy seen at our institution. Imaging plays a major role in their diagnosis and in determining the appropriate treatment.
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20
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Daellenbach L, Suter M. Jejunojejunal intussusception after Roux-en-Y gastric bypass: a review. Obes Surg 2011; 21:253-63. [PMID: 20949329 DOI: 10.1007/s11695-010-0298-5] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Small bowel intussusception is a rare long-term complication after Roux-en-Y gastric bypass, the etiology of which remains unclear. Except for one series reporting on 23 patients, case reports represent the vast majority of all cases reported so far. With this complete review of the world literature, based on a total of 63 patients including 2 of our own cases, we provide an extensive overview of the subject. The origin of intussusception after gastric bypass is different from that of intussusception of other causes, in that there is usually no lead point. It is likely related to motility disorders in the divided small bowel, especially in the Roux limb. This rare condition may cause obstruction and lead to bowel necrosis if not recognized and treated promptly. Clinical presentation is not specific. Computerized tomography scan represents the diagnostic test of choice, but surgery is sometimes the only way to establish the diagnosis. Treatment may be limited to reduction if the small bowel is viable, but resection of the affected segment is recommended on the basis of this review, since it seems to result in fewer recurrences. Knowledge of this entity and a high index of suspicion are required to make the correct diagnosis and offer appropriate treatment in a timely fashion.
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Affiliation(s)
- Loic Daellenbach
- Faculty of Medicine and Biology, University of Lausanne, Lausanne, Switzerland
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21
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Lo Menzo E, Stevens N, Kligman M. Plication followed by resection for intussusception after laparoscopic gastric bypass. Surg Obes Relat Dis 2010; 6:563-5. [PMID: 20870189 DOI: 10.1016/j.soard.2010.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Revised: 06/09/2010] [Accepted: 06/10/2010] [Indexed: 11/20/2022]
Affiliation(s)
- Emanuele Lo Menzo
- Center for Weight Management and Wellness, University of Maryland Medical Center, Baltimore, Maryland 21201, USA.
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Intussusception in traditional pediatric, nontraditional pediatric, and adult patients. Am J Emerg Med 2010; 29:523-7. [PMID: 20825824 DOI: 10.1016/j.ajem.2009.11.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Accepted: 11/29/2009] [Indexed: 11/24/2022] Open
Abstract
STUDY OBJECTIVES We sought to determine the rate of intussusception in 3 age groups (traditional pediatric-age [T], nontraditional pediatric-age [N], and adult-age [A]) and to compare group characteristics. METHODS We conducted a retrospective records review for patients discharged with diagnosis of intussusception between October 1999 and June 2008. RESULTS Ninety-five cases of intussusception were diagnosed as follows: 61 T (64%), 12 N (13%), and 22 A (23%). Bloody stool was more common in T patients (P = .016). Air contrast enema (36%) and ultrasound (33%) were the most common diagnostic tests in T, whereas computed tomography was most common in N (83%) and A (68%) patients. Bowel resection occurred more often in older (T) patients (P = .001). The most frequent causative pathologic conditions were adenitis (T), Peutz-Jeghers polyp (N), and carcinoma (A) and prior gastric bypass in 10 A patients. CONCLUSIONS The incidence of intussusception is substantially higher in nontraditional age groups than previously reported. Symptoms, management strategies, and causative pathologic conditions varied with age. All adults with intussusception require definitive diagnostic testing to determine the cause, given the concerning list of possibilities we observed.
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24
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Anterograde intussusception following laparoscopic Roux-en-Y gastric bypass: a case report and review of the literature. Obes Surg 2009; 20:1191-4. [PMID: 20020221 DOI: 10.1007/s11695-009-0037-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Accepted: 11/17/2009] [Indexed: 10/20/2022]
Abstract
Intussusception is a rare but worrisome cause of bowel obstruction in patients following Roux-en-Y gastric bypass. When intussusceptions is discovered in the general adult population, most often there is a "lead-point"; however, following bariatric procedures, this may not be true. There appears to be an increased incidence of this condition in open compared to laparoscopic Roux-en-Y gastric bypass procedures. Intussusception is often difficult to diagnose, especially in this population. Symptoms and signs can be very vague, and even computed tomography may not be accurate in diagnosing this condition. A high index of suspicion is required to successfully diagnose intussusception, and treatment often requires exploration and bowel resection. Herein, we report a case that follows several of these trends and suggests other possible contributions to intussusception. We also review other cases of intussusception after laparoscopic gastric bypass reported in the literature.
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25
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Dib MJ, Ho KJ, Hanto DW, Karp SJ, Johnson SR. Roux limb volvulus after pancreas transplantation: an unusual cause of pancreatic graft loss. Clin Transplant 2009; 23:807-11. [DOI: 10.1111/j.1399-0012.2008.00945.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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26
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Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Spitz AF, Apovian CM, Livingston EH, Brolin R, Sarwer DB, Anderson WA, Dixon J, Guven S. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Obesity (Silver Spring) 2009; 17 Suppl 1:S1-70, v. [PMID: 19319140 DOI: 10.1038/oby.2009.28] [Citation(s) in RCA: 199] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice are systematically developed statements to assist health-care professionals in medical decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied. These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area are expected, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with their best clinical judgment. The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines must be made in light of local resources and individual patient circumstances. The American Society for Parenteral & Enteral Nutrition fully endorses sections of these guidelines that address the metabolic and nutritional management of the bariatric surgical patient.
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Adult jejunojejunal intussusception after jejunoileal bypass bariatric surgery. Obes Surg 2009; 19:809-11. [PMID: 19296185 DOI: 10.1007/s11695-009-9828-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Accepted: 03/10/2009] [Indexed: 10/21/2022]
Abstract
The jejunoileal bypass is one of the bariatric surgical options which have been abandoned for two reasons: first, it leads to severe malnutrition and liver failure and, second, the bypassed jejunum-being a blind loop-is susceptible to bacterial accumulation which might become a source of sepsis due to bacterial translocation. We hereby report a case of a 27-year-old lady who presented with jejunojejunal intussusception of the blind jejunal loop 2 years after jejunoileal bypass surgery. This complication could have led to serious consequences if it was not managed in the appropriate time.
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Rabelaza A, Bringer JP, Passebois L, Dambron P, Bendahou S. [Ileocolic volvulus within Peterson's space: case report of an unusual complication of laparascopic Roux-en-Y gastric bypass]. JOURNAL DE CHIRURGIE 2009; 146:70-71. [PMID: 19446698 DOI: 10.1016/j.jchir.2009.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- A Rabelaza
- Service de chirurgie viscérale, digestive, thoracique et urologique, centre hospitalier de Béziers, 4, rue Valentin-Haüy, 34500 Béziers, France.
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Synchronous Intussusceptions Following Roux-en-Y Gastric Bypass: Case Report and Review of the Literature. Obes Surg 2009; 19:1719-23. [DOI: 10.1007/s11695-008-9797-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2008] [Accepted: 12/05/2008] [Indexed: 12/21/2022]
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Retrograde intussusception after Roux-en-Y gastric bypass for morbid obesity. Obes Surg 2008; 19:381-4. [PMID: 19067088 DOI: 10.1007/s11695-008-9775-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Accepted: 11/19/2008] [Indexed: 10/21/2022]
Abstract
Intussusception after Roux-en-Y gastric bypass procedure (RYGBP) is a rare complication that typically presents late after open or laparoscopic procedures with intermittent partial or complete bowel obstruction. It may be antegrade (peristaltic) or retrograde (antiperistaltic) and usually the common channel is affected. We describe an unusual case of retrograde intussusception that occurred 2 years after a laparoscopic RYGBP in which the proximal common channel had invaginated into the distal anastomotic site and the distal Roux limb.
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Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Guven S, Spitz AF, Apovian CM, Livingston EH, Brolin R, Sarwer DB, Anderson WA, Dixon J. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Endocr Pract 2008; 14 Suppl 1:1-83. [PMID: 18723418 DOI: 10.4158/ep.14.s1.1] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Tohamy AE, Eid GM. Laparoscopic reduction of small bowel intussusception in a 33-week pregnant gastric bypass patient: surgical technique and review of literature. Surg Obes Relat Dis 2008; 5:111-5. [PMID: 19161938 DOI: 10.1016/j.soard.2008.09.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Revised: 08/03/2008] [Accepted: 09/08/2008] [Indexed: 11/29/2022]
Affiliation(s)
- Aley Eldin Tohamy
- Division of Minimally Invasive Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA
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Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Guven S, Spitz AF, Apovian CM, Livingston EH, Brolin R, Sarwer DB, Anderson WA, Dixon J. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Surg Obes Relat Dis 2008; 4:S109-84. [PMID: 18848315 DOI: 10.1016/j.soard.2008.08.009] [Citation(s) in RCA: 191] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice are systematically developed statements to assist healthcare professionals in medical decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied. These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area are expected, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with their best clinical judgment. The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines must be made in light of local resources and individual patient circumstances. The American Society for Parenteral & Enteral Nutrition fully endorses sections of these guidelines that address the metabolic and nutritional management of the bariatric surgical patient.
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Pauli EM, Haluck RS. Antiperistaltic (retrograde) intussusception after laparoscopic Roux-en-Y gastric bypass procedure. Surg Obes Relat Dis 2008; 4:567-8. [PMID: 18586573 DOI: 10.1016/j.soard.2008.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2008] [Revised: 02/11/2008] [Accepted: 02/12/2008] [Indexed: 10/21/2022]
Affiliation(s)
- Eric M Pauli
- Section of Minimally Invasive and Bariatric Surgery, Pennsylvania State University, Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA
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Lessmann J, Soto E, Merola S. Intussusception after Roux-en-Y gastric bypass for morbid obesity. Surg Obes Relat Dis 2008; 4:664-7. [PMID: 18407805 DOI: 10.1016/j.soard.2007.12.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2007] [Accepted: 12/11/2007] [Indexed: 11/30/2022]
Affiliation(s)
- Juan Lessmann
- Department of Surgery, New York Hospital Queens, Flushing, New York 11355, USA
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Wang C, Ren Y, Chen J, Hu Y, Yang J, Xu P, Pan Y, Li J. Fatal fulminant pancreatitis after laparoscopic gastric bypass surgery. Obes Surg 2008; 18:1498-501. [PMID: 18369682 DOI: 10.1007/s11695-008-9486-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Accepted: 02/28/2008] [Indexed: 11/25/2022]
Abstract
Current widespread application of laparoscopic techniques in Roux-en-Y gastric bypass (RYGBP) is making surgical safety an increasingly important issue. We report one case that resulted in death due to postoperative fulminant acute pancreatitis after laparoscopic RYGBP was performed when this procedure was still relatively new in China. The patient was a chronically obese 19-year-old male. Weight loss medications had been ineffective, and preoperative body mass index was 40.7. Preoperative examination revealed moderate steatohepatitis. Laparoscopic RYGBP (LRYGBP) was performed. Early manifestations of clinical shock appeared 13 h after the laparoscopic surgery. A second laparoscopic examination showed small-vessel hemorrhage at the posterior wall of the jejunojejunal anastomosis, with blood clot formation resulting in Roux limb and afferent loop obstruction. Fulminant acute pancreatitis developed in the patient 18 h after the second surgery. The patient died 15 days later from systemic multiorgan insufficiency. LRYGBP (postcolon) is a technically demanding procedure for surgeons who are not experienced in this operation. In addition, surgical tolerance is reduced in morbidly obese patients. Therefore, special care should be taken during surgery, and hemostasis must be achieved at all bleeding sites. Increased perioperative surveillance allows for early detection and management of severe complications.
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Affiliation(s)
- Cunchuan Wang
- The Center of Minimally Invasive Surgery, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China.
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Simper SC, Erzinger JM, McKinlay RD, Smith SC. Retrograde (reverse) jejunal intussusception might not be such a rare problem: a single group's experience of 23 cases. Surg Obes Relat Dis 2008; 4:77-83. [PMID: 18294922 DOI: 10.1016/j.soard.2007.12.004] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2007] [Revised: 10/16/2007] [Accepted: 12/23/2007] [Indexed: 01/30/2023]
Abstract
BACKGROUND Retrograde (reverse) intussusception of the jejunum is thought to be a very rare occurrence, having been reported approximately 15 times (21 patients) in medical studies. A review of our own experience of >15,000 Roux-en-Y gastric bypass patients found 23 cases treated since 1996. This is the largest single-center report to date. METHODS A chart review dating back to 1996 revealed 23 patients with retrograde intussusception involving the jejunum. Their charts were reviewed. A variety of data was reviewed to identify the risk factors for developing intussusception, as well as the presentation, findings, and treatment. RESULTS We identified 23 patients with retrograde intussusception involving the jejunum. Of these 23 patients, 22 had undergone Roux-en-Y gastric bypass. One patient had undergone Roux-en-Y choledochojejunostomy. Of the 23 patients, 1 (4%) had a gastrojejunal intussusception and 22 (96%) jejunojejunal intussusceptions. All patients were women, with a median age of 32 years (range 20-50). The mean body mass index at gastric bypass was 45.2 kg/m2 (range 39.4-55). Of the 23 patients, 19 (83%) had undergone open and 4 (17%) laparoscopic gastric bypass. The median duration from gastric bypass to the diagnosis of intussusception was 51 months (range 6-288). Of the 23 patients, 8 (35%) presented with gangrene, perforation, or nonreducable obstruction, 9 (39%) had a spontaneous reduction, and in 6 (26%), the obstruction was successfully reduced at surgery. The treatment was surgical resection in 16 (70%) with 2 recurrences (12.5%), simple reduction in 2 (9%) with 100% recurrence, and plication in 5 patients (22%) with 2 recurrences (40%). CONCLUSION Retrograde intussusception of the jejunum after gastric bypass is probably more common than previously believed. Although resection and revision of the area of intussusception appears to be effective, more information is needed about the treatment and possible prevention of this disorder.
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Affiliation(s)
- Steven C Simper
- Rocky Mountain Associated Physicians, Salt Lake City, Utah 84124, USA.
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Al-Sabah S, Christou N. Intussusception after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2008; 4:205-9. [DOI: 10.1016/j.soard.2007.09.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Revised: 08/29/2007] [Accepted: 09/22/2007] [Indexed: 11/25/2022]
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Imaging in Bariatric Surgery: A Guide to Postsurgical Anatomy and Common Complications. AJR Am J Roentgenol 2008; 190:122-35. [DOI: 10.2214/ajr.07.2134] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Zainabadi K, Ramanathan R. Intussusception After Laparoscopic Roux-en-Y Gastric Bypass. Obes Surg 2007; 17:1619-23. [DOI: 10.1007/s11695-007-9291-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Accepted: 09/15/2007] [Indexed: 01/08/2023]
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Gigena M, Villar HV, Knowles NG, Cunningham JT, Outwater EK, Leon Jr LR. Antegrade bowel intussusception after remote Whipple and Puestow procedures for treatment of pancreas divisum. World J Gastroenterol 2007; 13:5954-6. [PMID: 17990363 PMCID: PMC4205444 DOI: 10.3748/wjg.v13.i44.5954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
To date, antegrade intussusception involving a Roux-en-Y reconstruction has been reported only once. We report a case of acute bowel obstruction due to an intussusception involving two Roux-en-Y limbs in a 40-year-old woman with a history of chronic pancreatitis due to pancreas divisum. Four years preceding this event, the patient had undergone a Whipple procedure, and three years prior to that, a Puestow operation. The patient was successfully treated with bowel resection and a side-to-side anastomosis between the most distal aspect of the bowel and the most distal Roux-en-Y reconstruction, which preserved both Roux-en-Y reconstructions.
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Sukeik M, Alkari B, Ammori BJ. Abdominal wall hernia during laparoscopic gastric bypass: A serious consideration. Obes Surg 2007; 17:839-42. [PMID: 17879589 DOI: 10.1007/s11695-007-9129-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Morbidly obese patients are predisposed to developing abdominal wall hernias with the potential complication of small bowel obstruction. We report a patient who developed an obstructed paraumbilical hernia a few days after laparoscopic gastric bypass and died of aspiration pneumonia after re-laparoscopy. The controversy regarding the optimal time and method of repair of abdominal wall hernias in patients undergoing laparoscopic gastric bypass is discussed with emphasis placed on either a simultaneous repair or to split the omentum to one side leaving incarcerated omentum that is plugging the hernia defect in place for a delayed repair.
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Affiliation(s)
- Mohamed Sukeik
- Department of Surgery, Manchester Royal Infirmary, Manchester, UK
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Coster DD, Sundberg SM, Kermode DS, Beitzel DT, Noun SH, Severidt M. Small bowel obstruction due to antegrade and retrograde intussusception after gastric bypass: three case reports in two patients, literature review, and recommendations for diagnosis and treatment. Surg Obes Relat Dis 2007; 4:69-72. [PMID: 17974496 DOI: 10.1016/j.soard.2007.08.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Revised: 07/15/2007] [Accepted: 08/24/2007] [Indexed: 11/18/2022]
Abstract
Intestinal obstruction due to intussusception, although rare, is a complication that can cause small bowel obstruction after Roux-en-Y gastric bypass. Possible causes include disordered intestinal motility, the presence of staple lines and other lead points in the intestinal wall, and the anatomic peculiarities of the enteroenterostomy. In the case of antegrade intussusception, the lead point is usually identifiable and can involve either limb. Retrograde intussusception is more common but usually has a featureless entry point beginning a few inches below the intestinal anastomosis, with the intussusceptum traversing the enteroenterostomy into either the biliary or Roux limb. Abdominal computed tomography scan is necessary for diagnosis, and early exploration is recommended to avoid ischemia and bowel resection.
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Affiliation(s)
- David D Coster
- Grinnell Bariatrics and Department of Surgery, Grinnell Regional Medical Center, Grinnell, Iowa, USA
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