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Shergill K, Boppana K, Almansouri NE, Bakkannavar S, Faheem Y, Jaiswal A, Butt SRR. Intussusception and Gut Dysmotility: A Systematic Review Assessing Unexpected Complications of Bariatric Surgery. Cureus 2024; 16:e58086. [PMID: 38741821 PMCID: PMC11088965 DOI: 10.7759/cureus.58086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 04/11/2024] [Indexed: 05/16/2024] Open
Abstract
Bariatric surgery, although effective in treating obesity-related comorbidities, rarely results in intussusception, which is a severe complication. This study aimed to enhance clinical practice and establish early diagnosis by elucidating risk factors and management strategies associated with intussusception. We conducted this systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 criteria. We looked through PubMed, PubMed Central, ScienceDirect, ScienceOpen, MyScienceWork, Hyper Articles en Ligne (HAL), Google Scholar, and the Medical Literature Analysis and Retrieval System Online for relevant studies and research. Articles were screened according to inclusion and exclusion criteria, and relevance. We employed pertinent quality appraisal instruments to look for bias. Initially, we discovered 2,833 items. We eliminated redundant and unnecessary publications. After reviewing all the articles, we selected 30 studies based on their titles and abstracts. Out of the 30 studies reviewed, 12 papers were included in this review, with the remaining 18 being eliminated due to low quality. Medical practitioners and surgeons have a responsibility to meticulously monitor and provide postoperative surveillance, with a particular emphasis placed on individuals exhibiting symptoms of abdominal pain and vomiting, as there is a clinical imperative to consider the possibility of intussusception. The management approach, whether conservative or surgical, remains contingent upon the clinical context.
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Affiliation(s)
- Kainaat Shergill
- Department of General Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Medicine, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, IND
| | - Kusalik Boppana
- Department of Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Naiela E Almansouri
- Department of Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Department of Internal Medicine, University of Tripoli, Tripoli, LBY
| | - Saloni Bakkannavar
- Department of Pediatrics, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Youmna Faheem
- Department of Pediatrics, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Amisha Jaiswal
- Department of Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Samia Rauf R Butt
- Department of Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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2
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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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3
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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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4
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Bonouvrie DS, Janssen L, Niemarkt HJ, van Laar JOEH, Leclercq WKG, van Dielen FMH. Small bowel intussusception in pregnant women with a history of a Roux-en-Y gastric bypass: a case series and a systematic review of the literature. Surg Obes Relat Dis 2020; 16:1603-1613. [PMID: 32737008 DOI: 10.1016/j.soard.2020.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 04/17/2020] [Accepted: 05/18/2020] [Indexed: 12/16/2022]
Abstract
Intussusception of the small intestine has been described in pregnant women with a history of a laparoscopic Roux-en-Y gastric bypass. This study provides a systematic review on the characteristics of intussusception in this population. MEDLINE, Embase, Cochrane Library, and our own hospital's electronics health records were searched for eligible studies/cases. Fifteen papers were eligible, containing 17 cases. Our hospital search included 6 cases. Seventeen of 23 intussusceptions were retrograde and were mostly (18/23) located at the jejunojejunostomy. Six patients were treated successfully with manual reduction only and 17 patients required surgical resection. Fifteen (65%) patients had an ischemic segment. Six (26%) patients delivered during the same hospital admission. One fetal death (1 of twins) was reported. Awareness of this rare but serious complication by obstetricians and bariatric surgeons is necessary to limit maternal and fetal complications.
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Affiliation(s)
| | - Loes Janssen
- Department of Surgery, Máxima Medical Center, Veldhoven, the Netherlands
| | - Hendrik J Niemarkt
- Department of Neonatology, Máxima Medical Center, Veldhoven, the Netherlands
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5
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Musbahi A, Brown L, Sultan W, Rao M, Gopinath B. Intussusception During Pregnancy Following Roux-en-Y Gastric Bypass: A Literature Review. Bariatr Surg Pract Patient Care 2019. [DOI: 10.1089/bari.2019.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Aya Musbahi
- University Hospital North Tees, Stockton-on-Tees, United Kingdom
| | - Leo Brown
- University Hospital North Tees, Stockton-on-Tees, United Kingdom
| | - Wassem Sultan
- University Hospital North Tees, Stockton-on-Tees, United Kingdom
| | - Milind Rao
- University Hospital North Tees, Stockton-on-Tees, United Kingdom
| | - Bussa Gopinath
- University Hospital North Tees, Stockton-on-Tees, United Kingdom
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6
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Hu L, Yin G, Zhang D, Geng Z, Bai J. Tube feeding associated postoperative intussusceptions: A single center case series study. Medicine (Baltimore) 2019; 98:e17783. [PMID: 31689848 PMCID: PMC6946534 DOI: 10.1097/md.0000000000017783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
RATIONALE Postoperative intussusception in adults is a rare but serious complication after gastrointestinal anastomosis surgery. Postoperative intussusception in adults caused by tube feeding was rarely been reported before. The aim of the current study was to summarize the clinical data on a group of patients with tube feeding associated postoperative intussusceptions. The possible etiology and preventive measures will also be discussed. PATIENT CONCERNS During the period from May 2013 to January 2018, patients who received gastrointestinal anastomosis in our center were retrospectively reviewed. Preoperative variables including standard demographic and pathological characteristics as well as the treatment and prognosis were also analyzed. DIAGNOSES Tube feeding associated postoperative intussusceptions. INTERVENTIONS 7 patients were identified with tube feeding associated postoperative intussusceptions with a prevalence of 0.38%. Intussusceptions occurred from 10 to 69 days (median 25.7 days) postoperatively in an acute form. OUTCOMES None of the patients had spontaneous reduction and all patients underwent surgery. Antegrade efferent limb intussusceptions were found in all the cases. Intussusception occurred at efferent loop at 23.6 cm (range 15-60) from the gastrointestinal or Braun anastomosis. None of the patients was found recurrence throughout the follow-up period. LESSONS In contrast with other postoperative intussusceptions, the tube feeding associated postoperative intussusceptions have special clinical manifestations. It is more likely to occur in early period of time after the surgery and in an acute form. Surgical correction is recommended for most of patients. Several measures have been proposed to prevent such complications after gastrointestinal surgery, however more research and information are still needed.
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7
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Petrucciani N, Ciangura C, Debs T, Ducarme G, Calabrese D, Gugenheim J. Management of surgical complications of previous bariatric surgery in pregnant women. A systematic review from the BARIA-MAT Study Group. Surg Obes Relat Dis 2019; 16:312-331. [PMID: 31837948 DOI: 10.1016/j.soard.2019.10.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/14/2019] [Accepted: 10/22/2019] [Indexed: 12/29/2022]
Abstract
Considering the large and increasing population of women of childbearing age with history of bariatric surgery, surgical complications of bariatric surgery during pregnancy may become more frequent in the future. The aim of this study was to analyze the clinical presentation, diagnostic procedures, and treatment of surgical complications of bariatric surgery during pregnancies. A systematic literature search was performed in accordance with the PRISMA (preferred reporting items for systematic review and meta-analysis) guidelines to identify all studies published up to and including December 2018 that included women with previous bariatric surgery undergoing emergency surgery during pregnancy. Sixty-eight studies were selected, including 120 women with previous bariatric surgery undergoing emergency surgery during pregnancy. Fifty cases were reported as case reports and 70 in case series. Included patients had previous history of Roux-en-Y gastric bypass (n = 99), laparoscopic adjustable gastric banding (n = 17), Scopinaro procedure (n = 2), vertical banded gastroplasty (n = 1), or one-anastomosis gastric bypass (n = 1). Final diagnosis in 50 case reports was internal hernia in 26 cases, bowel intussusception in 10, intestinal obstruction in 2, laparoscopic adjustable gastric banding slippage in 3, bowel volvulus in 3, gastric or jejunal perforation in 2, and other complications in 4 cases. Maternal and fetal death occurred in 3 (2.5%) and 9 cases (7.5%), respectively. In the case series, the majority of women were operated for internal hernia and laparoscopic adjustable gastric banding slippage. Surgical complications of previous bariatric surgery during pregnancy have potentially severe outcomes. Availability of multidisciplinary expertise, including bariatric/digestive surgeons, and education of healthcare providers and women on clinical signs that require urgent surgical examination are recommended in this setting. Prompt diagnosis is fundamental and based on clinical and laboratory findings and on radiologic examinations if needed, including computed tomography scan or magnetic resonance if available. Rapid surgical exploration is mandatory in case of high clinical and/or radiologic suspicion.
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Affiliation(s)
- Niccolo Petrucciani
- Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, Nice, France; Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University, Rome, Italy.
| | - Cecile Ciangura
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Nutrition, Sorbonne Université, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Tarek Debs
- Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, Nice, France
| | - Guillaume Ducarme
- Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, La Roche-sur-Yon, France
| | - Daniela Calabrese
- Assistance Publique-Hôpitaux de Paris, Louis Mourier Hospital, Digestive Surgery Department, Sorbonne Paris Cité Diderot, Colombes, France
| | - Jean Gugenheim
- Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, Nice, France
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8
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Machado A, Carvalho M, Caravana J. Laparoscopic resolution of intussusception after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2018; 14:1916-1918. [DOI: 10.1016/j.soard.2018.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022]
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9
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Bhadra R, Somasundaram M, Nowak MM, Ravakhah K. A near-fatal case of intussusception and ischaemic perforation of stomach in first-trimester pregnancy: eight years after laparoscopic Roux-en-Y gastric bypass. BMJ Case Rep 2018; 11:11/1/e226094. [PMID: 30567094 DOI: 10.1136/bcr-2018-226094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The increasing demand and popularity of bariatric surgery are not only due to the ever-increasing obesity epidemic but to tackle obesity-related comorbidities like diabetes and hypertension. However, bariatric surgery is not free of complications. One rare complication is intussusception, jejuno-jejunal intussusception being the most common. Intussusception has been defined both in pregnant and in non-pregnant women as well as men. We describe the case of a 40-year-old woman in the first trimester of pregnancy came to the hospital with worsening abdominal pain, was found to have intussusception of small bowel involving the jejunum, along with ischaemic perforation and necrosis of the fundus of the stomach. Postsurgery, the patient had a complete recovery and eventually, she successfully delivered an intact, viable fetus.
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Affiliation(s)
- Rajarshi Bhadra
- Internal Medicine, St. Vincent Charity Medical Center, Cleveland, Ohio, USA
| | | | - Michael M Nowak
- St. Vincent Charity Medical Center, The Center for Bariatric Surgery, Cleveland, Ohio, USA
| | - Keyvan Ravakhah
- Internal Medicine, St. Vincent Charity Medical Center, Cleveland, Ohio, USA
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10
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Boccalatte LA, Achaval Rodríguez J, Beskow A, Cavadas D, Fernando W. Intussusception as a complication of bariatric surgery in pregnant patients: report of one case and revision of the literature. J Surg Case Rep 2017; 2017:rjx189. [PMID: 29026515 PMCID: PMC5632341 DOI: 10.1093/jscr/rjx189] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 09/06/2017] [Indexed: 12/19/2022] Open
Abstract
Occlusive complications after a laparoscopic Roux-in Y gastric bypass (LRYGB), appear mainly as fibrous membranes of wounds, internal hernias or intussusception. Intussusception after a bariatric surgery occurs in 0.1-0.3% of the cases. We present a case of intussusception in a pregnant patient after a LRYGB.
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Affiliation(s)
- Luis A Boccalatte
- Deparment of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina
| | - Juan Achaval Rodríguez
- Deparment of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina
| | - Axel Beskow
- Deparment of Bariatric Surgery, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB,Argentina
| | - Demetrio Cavadas
- Deparment of Bariatric Surgery, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB,Argentina
| | - Wright Fernando
- Deparment of Bariatric Surgery, Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB,Argentina
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11
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Mortelmans D, Mannaerts D, Van den Broeck S, Jacquemyn Y, Hubens G. Intussusception in pregnancy after gastric bypass: a case report. Acta Chir Belg 2016; 116:379-382. [PMID: 27426666 DOI: 10.1080/00015458.2016.1181311] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Laparoscopic Roux-en-Y gastric bypass (RYGB) remains the gold standard procedure in obesity surgery and is mostly performed in young women of reproductive age. Since the worldwide prevalence of obesity is increasing and fertility improves after surgery, more complications in the pregnant population will emerge. The differential diagnosis of acute abdominal pain in patients with a history of gastric bypass is rather broad and includes mainly anastomotic ulcers, leaks, and small bowel obstructions. Early diagnosis and treatment of these complications is of utmost importance and should be performed on a multidisciplinary basis. Whether surgery should be performed by laparoscopy or laparotomy remains subject of discussion. We report a case of a 29-year-old pregnant woman at 33 + 5 weeks gestational age, presenting with an intussusception after RYGB. A successful surgical reduction was performed by laparotomy.
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Affiliation(s)
- D. Mortelmans
- Department of Abdominal, Pediatric and Plastic Surgery, University Hospital of Antwerp, Antwerp, Belgium
| | - D. Mannaerts
- Department of Obstetrics and Gynecology, University Hospital of Antwerp, Antwerp, Belgium
| | - S. Van den Broeck
- Department of Abdominal, Pediatric and Plastic Surgery, University Hospital of Antwerp, Antwerp, Belgium
| | - Y. Jacquemyn
- Department of Obstetrics and Gynecology, University Hospital of Antwerp, Antwerp, Belgium
| | - G. Hubens
- Department of Abdominal, Pediatric and Plastic Surgery, University Hospital of Antwerp, Antwerp, Belgium
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12
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Arapis K, Tammaro P, Goujon G, Becheur H, Augustin P, Marmuse JP. Elevated plasma pancreatic enzyme concentrations after Roux-en-Y gastric bypass may indicate closed loop obstruction. Ann R Coll Surg Engl 2016; 99:e62-e64. [PMID: 27791421 DOI: 10.1308/rcsann.2016.0334] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Laparoscopic Roux-en-Y gastric bypass is one of the most commonly performed bariatric procedures and most patients are women of reproductive age. Consequently, general surgeons and obstetricians need to be aware that these patients are at risk of bariatric specific surgical complications during their pregnancy. We report a case involving a 32-year-old woman who had undergone Roux-en-Y gastric bypass surgery 2 years previously. She presented at 25 weeks of gestation with a closed loop obstruction due to a retrograde jejunojejunal intussusception that was initially misdiagnosed as acute pancreatitis.
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Affiliation(s)
- K Arapis
- Bichat-Claude Bernard Hospital , Paris , France
| | - P Tammaro
- Bichat-Claude Bernard Hospital , Paris , France
| | - G Goujon
- Bichat-Claude Bernard Hospital , Paris , France
| | - H Becheur
- Bichat-Claude Bernard Hospital , Paris , France
| | - P Augustin
- Bichat-Claude Bernard Hospital , Paris , France
| | - J P Marmuse
- Bichat-Claude Bernard Hospital , Paris , France
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13
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Bokslag A, Jebbink J, De Wit L, Oudijk M, Ribbert L, Tahri S, van Pampus M, van Pampus M. Intussusception during pregnancy after laparoscopic Roux-en-Y gastric bypass. BMJ Case Rep 2014; 2014:bcr-2014-205357. [PMID: 25406213 DOI: 10.1136/bcr-2014-205357] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In fertile women, the laparoscopic Roux-en-Y gastric bypass (LRYGB) is being increasingly performed. Pregnancy and LRYGB both give an increased risk of intussusception, which can lead to bowel necrosis, sepsis and preterm labour. We describe two pregnant women with a history of LRYGB who presented to the emergency department with non-specific abdominal pain. Both were diagnosed with intussusception. These cases illustrate that intussusception should be considered in pregnant women with a history of LRYGB who present with non-specific abdominal pain. Only MRI, CT scan or diagnostic laparoscopy is sufficient for diagnosis. Early diagnosis may prevent serious complications.
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Affiliation(s)
- Anouk Bokslag
- Department of Gynaecology & Obstetrics, OLVG, Amsterdam, The Netherlands
| | - Jiska Jebbink
- Department of Gynaecology & Obstetrics, OLVG, Amsterdam, The Netherlands
| | | | - Martijn Oudijk
- Department of Gynaecology & Obstetrics, UMCU, Utrecht, The Netherlands
| | - Lucie Ribbert
- Department of Gynaecology & Obstetrics, UMCU, Utrecht, The Netherlands
| | - Sabrin Tahri
- Department of Gynaecology & Obstetrics, UMCU, Utrecht, The Netherlands
| | - Maria van Pampus
- Department of Gynaecology & Obstetrics, OLVG, Amsterdam, The Netherlands
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14
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Tutar O, Kocak B, Velidedeoglu M, Baca B, Dikici S, Nurili F, Kantarci F. Small bowel intussusception in a pregnant woman with Peutz-Jeghers Syndrome. Scott Med J 2014; 59:e9-13. [PMID: 24448402 DOI: 10.1177/0036933013519028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Intussusception is the most frequent complication of Peutz-Jeghers Syndrome (PJS), but usually seen in child age. It is a predictable, but infrequent complication in adults with PJS. However, there is no report about intussusception in pregnancy period secondary to Peutz-Jeghers (PJ) polyps in the literature. In this paper, we present a rare intussusception case in a pregnant woman with PJS, which was diagnosed with magnetic resonance imaging, and discuss this condition with a brief literature review.
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Affiliation(s)
- Onur Tutar
- MD, Istanbul University, Cerrahpasa Medical Faculty, Department of Radiology, Istanbul, Turkey
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15
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Wax JR, Pinette MG, Cartin A. Roux-en-Y gastric bypass-associated bowel obstruction complicating pregnancy-an obstetrician's map to the clinical minefield. Am J Obstet Gynecol 2013; 208:265-71. [PMID: 22964065 DOI: 10.1016/j.ajog.2012.08.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 07/31/2012] [Accepted: 08/07/2012] [Indexed: 12/23/2022]
Abstract
Over 80% of patients undergoing bariatric surgery are women, approximately half of whom are of reproductive age. The most common procedure in the United States is the Roux-en-Y gastric bypass. Small bowel obstruction is one of many recognized postoperative complications. For such a serious condition, this entity presents with remarkable subtlety and is easily misdiagnosed, particularly in pregnant women. The consequences of late recognition can be life-threatening to both mother and fetus. We aim to decrease preventable maternal and perinatal morbidity and mortality by revealing diagnostic and therapeutic missteps related to Roux-en-Y gastric bypass-associated small bowel obstruction.
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Affiliation(s)
- Joseph R Wax
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maine Medical Center, Portland, ME, USA
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16
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Tuyeras G, Pappalardo E, Msika S. Acute small bowel obstruction following laparoscopic Roux-en-Y gastric bypass during pregnancy: two different presentations. J Surg Case Rep 2012; 2012:1. [PMID: 24960726 PMCID: PMC3649561 DOI: 10.1093/jscr/2012.7.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Bariatric surgery as laparoscopic Roux-en-Y gastric bypass (LRYGB) is increasing throughout the world and women represent the majority (70%) of patients. Most of them are of reproductive age. As a consequence, surgeons will have to treat more and more pregnant patients with a history of LRYGB for surgical abdominal pain. Reported incidence of small bowel obstruction (SBO) varies from 1.5% to 3.5% after LRYGB including internal hernias, intussusception and volvulus. As two cases of maternal postoperative death have been reported in the literature, diagnosis and surgical treatment shouldn’t be delayed especially during pregnancy. To underline the necessity of a rapid diagnosis and surgical treatment, we reported two cases of severe SBO during pregnancy.
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Affiliation(s)
- G Tuyeras
- Hôpital Louis Mourier, Paris, France
| | | | - S Msika
- Hôpital Louis Mourier, Paris, France
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17
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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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18
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Laparoscopic repair of internal hernia during pregnancy after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2010; 6:88-92. [DOI: 10.1016/j.soard.2009.06.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Revised: 06/04/2009] [Accepted: 06/04/2009] [Indexed: 11/23/2022]
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