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Branch K, Poa-Li C, Scharf K. Case report: Concurrent intussusception and bleeding marginal ulcer in a patient with gastric bypass. Int J Surg Case Rep 2024; 121:109951. [PMID: 38954971 PMCID: PMC11263715 DOI: 10.1016/j.ijscr.2024.109951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 06/19/2024] [Accepted: 06/24/2024] [Indexed: 07/04/2024] Open
Abstract
INTRODUCTION The source of abdominal pain in patients with a history of gastric bypass can be difficult to determine. Synchronous disease processes may ultimately be the cause of their symptoms. Among the etiologies for hematemesis and obstruction in this population are the diagnoses of marginal ulcer and internal hernia. Given the potential complications of bariatric surgery, it is important to maintain a broad differential diagnosis during the workup of these patients. PRESENTATION A female with history of laparoscopic Roux-en-Y gastric bypass (RYGB) presented with abdominal pain and hematemesis. Intraoperative findings revealed intussusception of the jejunojejunostomy resulting in obstruction and ischemic bowel. Additionally, a perforated marginal ulcer of the Roux-limb was found to be present. This patient underwent esophagogastroduodenoscopy, bowel resection, jejunojejunostomy revision, and Graham patch repair. DISCUSSION This case highlights a patient with history of RYGB presenting with obstruction and gastrointestinal bleeding. Although initially diagnosed with internal hernia and Mallory-Weiss hematemesis, surgical exploration revealed concurrent intussusception and marginal ulceration. While intussusception is a rare complication of bariatric surgery, it can occur secondary to mesenteric thinning and motility dysfunction from significant weight loss. It is imperative to maintain a broad differential diagnosis for the causes of obstruction and GI bleeding that include adhesive disease, abdominal wall hernia, internal hernia, intussusception, and marginal ulcers. CONCLUSION Findings of obstruction or GI bleeding after bariatric surgery may represent a surgical emergency. While these symptoms may be attributed to a single diagnosis, clinicians must consider the presence of synchronous pathologies during the workup of patients.
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Affiliation(s)
- Kevin Branch
- Department of Surgery, Loma Linda University Health, Loma Linda, CA, USA.
| | - Christina Poa-Li
- Department of Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - Keith Scharf
- Department of Surgery, Loma Linda University Health, Loma Linda, CA, USA
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2
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ALSubhi M, Al Harbi A, Alkhunein JS. Intussusception Within a Jejunostomy With Closed Loop Obstruction: A Case Report. Cureus 2024; 16:e66644. [PMID: 39258089 PMCID: PMC11386521 DOI: 10.7759/cureus.66644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2024] [Indexed: 09/12/2024] Open
Abstract
Jejunojejunal intussusception is a rare yet severe complication of Roux-en-Y gastric bypass (RYGBP) surgery. We are presenting a unique case of retrograde jejunal intussusception with a closed-loop blockage and an associated abdominal herniation that occurred two years after a laparoscopic RYGBP. The patient presented with abdominal pain, nausea, and vomiting, prompting a clinical diagnosis and a biphasic contrast-enhanced computed tomography (CT) scan, which later revealed a complicated jejunal intussusception with signs of ischemia showing decreased wall enhancement and distal collapsed jejunal walls with complete closed-loop bowel obstruction. The case was successfully managed through emergent laparoscopy to repair the hernia and reduce the intussusception, after which the postoperative period was unremarkable. This article aims to raise awareness about this rare but significant postoperative complication and stress the importance of early medical attention in similar cases.
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Affiliation(s)
- Morooj ALSubhi
- Department of Medical Imaging, King Abdulaziz Medical City, Ministry of National Guard-Heath Affairs, Riyadh, SAU
| | - Abdulrahman Al Harbi
- Department of Medical Imaging, King Abdulaziz Medical City, Ministry of National Guard-Heath Affairs, Riyadh, SAU
| | - Jullanar S Alkhunein
- Collage of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
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3
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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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Mazzorana DI, Arif K, Huang J. Gastrostomy Exchange With Displacement Into the Jejunum. Cureus 2024; 16:e57444. [PMID: 38699118 PMCID: PMC11064739 DOI: 10.7759/cureus.57444] [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: 07/14/2023] [Accepted: 04/01/2024] [Indexed: 05/05/2024] Open
Abstract
A 54-year-old female with a gastrostomy tube presented with persistent nausea, vomiting, and abdominal pain. On physical examination, the gastrostomy tube was completely advanced into the abdominal cavity with only the external retention ring and hub on the exterior. The first step in the workup was obtaining a scout radiograph. This imaging was appropriate to show the location of the gastrostomy catheter which was overlying the left upper quadrant. The distal tip was heading in the direction of the left lower quadrant. The course of the gastrostomy catheter did not follow the expected direction of the duodenal C-loop. Proceeding forward, contrast was injected through the existing catheter which showed opacification of the jejunal bowel loops. The patient could now be properly diagnosed with gastroenteric intussusception and proper measures could be taken. Following the injected contrast showing jejunal opacification, a stiff Glidewire was advanced through the existing catheter all the way into the jejunum. Deflation of the balloon and removal of the catheter caused an almost instantaneous change in the course of the Glidewire to the more conventional path following the course of the duodenal C-loop. A sheath was then advanced over the wire which was now shown crossing the midline in the proper gastroduodenojejunal course. The final step was to advance a new 22-French MIC gastrostomy catheter over the Glidewire. The contrast was then injected to demonstrate proper opacification of the rugal folds and gastric fundus. The patient reported an immediate resolution of symptoms and was later discharged.
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Affiliation(s)
| | - Kamil Arif
- Interventional Radiology, University of Alabama at Birmingham, Birmingham, USA
| | - Junjian Huang
- Interventional Radiology, University of Alabama at Birmingham, Birmingham, USA
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5
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Chopko TC, Sudhindran V, Stephens D. Roux-en-Y retrograde intussusception: surgical reconstruction via sequential isoperistaltic side-to-side anastomoses. BMJ Case Rep 2024; 17:e258660. [PMID: 38367992 PMCID: PMC10875495 DOI: 10.1136/bcr-2023-258660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2024] Open
Abstract
Intussusception following Roux-en-Y gastric bypass is a rare, potentially life-threatening complication. Patients present with intermittent obstructive symptoms, and the diagnosis is made on imaging. Treatment is surgical considering the high likelihood of non-operative failure, strangulation, incarceration, perforation and concern for malignancy. We present the case of a woman in her 60s with a history of Roux-en-Y gastric bypass who presented with retrograde jejunojejunal intussusception at the distal Roux anastomosis. She proceeded to the operating room for complete anastomotic resection with reconstruction of three blind ends via two sequential isoperistaltic anastomoses. She progressed appropriately throughout her hospitalisation and was discharged on postoperative day 5 without recurrence. While intussusception in Roux-en-Y anatomy has been previously described, a literature review yielded sparse results in detailing its surgical correction. We highlight our unique surgical approach of jejunojejunal anastomotic resection with the creation of sequential isoperistaltic side-to-side anastomoses.
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Affiliation(s)
- Trevor C Chopko
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Daniel Stephens
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
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6
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Liagre A, Martini F, Debs T, Barone SC, Petrucciani N. Roux en Y gastric bypass and iterative intussusception at the jejuno-jejunal anastomosis: Conversion into one anastomosis gastric bypass (with video) - A case report. Int J Surg Case Rep 2024; 115:109244. [PMID: 38215577 PMCID: PMC10821620 DOI: 10.1016/j.ijscr.2024.109244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 01/14/2024] Open
Abstract
INTRODUCTION The aim of this article is to describe a rare complication of Roux en Y gastric bypass (RYGB): recurrent intestinal intussusception of the biliary limb, and an original treatment: the removal of the jejuno-jejunal anastomosis with conversion into "short limb" one anastomosis gastric bypass (OAGB). PRESENTATION OF CASE A 25-year-old patient underwent RYGB fashioned with a 50 cm-length biliary loop and a 150 cm-length alimentary loop. She was hospitalized other 3 times in the following months for episodes of acute abdominal pain and excessive weight loss, with CT scans showing intussusception at the jejuno-jejunal anastomosis. Conversion from RYGB to OAGB with "short biliary limb" was performed. The patient at 60-month follow-up has no bile reflux and regained weight. DISCUSSION Small bowel intussusception is a rare complication that can occur following Roux-en-Y gastric bypass (RYGB) surgery, leading to symptoms like acute or chronic abdominal pain. Treatment options reported in medical literature include resection and re-fashioning of the jejuno-jejunal anastomosis, simple reduction (with a risk of recurrence), and imbrication/plication of the jejuno-jejunal anastomosis. Given the rarity of this complication, there are no standardized recommendations, and the best treatment should be determined on a case-by-case basis, taking into consideration the patient's unique circumstances and the medical team's expertise. CONCLUSION Intestinal intussusception at the jejuno-jejunal anastomosis responsible for chronic abdominal pain is a rare complication after RYGB. One of the possible treatments is conversion into OAGB.
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Affiliation(s)
- Arnaud Liagre
- Clinique Des Cedres, Bariatric Surgery Unit, Ramsay Générale de Santé, Cornebarrieu, France
| | - Francesco Martini
- Clinique Des Cedres, Bariatric Surgery Unit, Ramsay Générale de Santé, Cornebarrieu, France
| | - Tarek Debs
- Institut Arnault Tzanck, 116 Rue du Commandant Gaston Cahuzac, 06700 Saint-Laurent-du-Var, France
| | - Sara Claudia Barone
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, Rome, Italy
| | - Niccolo Petrucciani
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, Rome, Italy.
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7
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Abstract
Importance Roux-en-Y gastric bypass (RYGB) remains one of the most commonly performed operations for morbid obesity and is associated with significant long-term weight loss and comorbidity remission. However, health care utilization rates following RYGB are high and abdominal pain is reported as the most common presenting symptom for those seeking care. Observations Given the limitations of physical examination in patients with obesity, correct diagnosis of abdominal pain following RYGB depends on a careful history and appropriate use of radiologic, laboratory and endoscopic studies, as well as a clear understanding of post-RYGB anatomy. The most common etiologies of abdominal pain after RYGB are internal hernia, marginal ulcer, biliary disease (eg, cholelithiasis and choledocholithiasis), and jejunojejunal anastomotic issues. Early identification of the etiology of the pain is essential, as some causes, such as internal hernia or perforated gastrojejunal ulcer, may require urgent or emergent intervention to avoid significant morbidity. While laboratory findings and imaging may prove useful, they remain imperfect, and clinical judgment should always be used to determine if surgical exploration is warranted. Conclusions and Relevance The etiologies of abdominal pain after RYGB range from the relatively benign to potentially life-threatening. This Review highlights the importance of understanding key anatomical and technical aspects of RYGB to guide appropriate workup, diagnosis, and treatment.
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Affiliation(s)
- Brian T Fry
- Department of Surgery, University of Michigan, Ann Arbor
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8
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Altieri MS, Rogers A, Afaneh C, Moustarah F, Grover BT, Khorgami Z, Eisenberg D. Bariatric Emergencies for the General Surgeon. Surg Obes Relat Dis 2023; 19:421-433. [PMID: 37024348 DOI: 10.1016/j.soard.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 02/04/2023] [Indexed: 02/16/2023]
Affiliation(s)
- Maria S Altieri
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Ann Rogers
- Department of Surgery, Hershey School of Medicine, Penn State University, Hershey, Pennsylvania
| | | | - Fady Moustarah
- Department of Surgery, Beaumont Hospital, Bloomfield Hills, Michigan
| | - Brandon T Grover
- Department of Surgery, Gundersen Lutheran Medical Center, La Crosse, Wisconsin
| | - Zhamak Khorgami
- Department of Surgery, University of Oklahoma College of Community Medicine, Tulsa, Oklahoma; Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Dan Eisenberg
- Department of Surgery, Stanford School of Medicine and VA Palo Alto Health Care System, Palo Alto, California
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9
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Zaigham H, Ekelund M, Lee D, Ekberg O, Regnér S. Intussusception After Roux-en-Y Gastric Bypass: Correlation Between Radiological and Operative Findings. Obes Surg 2023; 33:475-481. [PMID: 36474098 PMCID: PMC9889503 DOI: 10.1007/s11695-022-06377-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/20/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Intussusceptions diagnosed on computed tomography (CT) scans in Roux-en-Y gastric bypass (RYGB) patients could cause serious small bowel obstruction (SBO) or be an incidental finding. The objective of this study was to correlate radiological findings with clinical outcomes to differentiate intussusceptions requiring emergent surgery for SBO. METHODS A search for acute abdominal CT scans reporting intussusceptions in RYGB patients between 2012 and 2019 at Skåne University Hospital, Malmö, Sweden, retrieved 35 scans. These were independently reevaluated by two radiologists for the length and location of the intussusception, whether oral contrast passed through, proximal bowel dilatation, and signs of internal herniation. Clinical outcome in terms of emergency surgery and the diagnosis was determined through chart review. RESULTS Out of 35 acute patients, 9 patients required emergency surgery within 24 h. Intussusception caused SBO in five patients, and one patient had an internal herniation, while three patients had unremarkable findings. Eight patients were evaluated for intermittent pain with five unremarkable laparoscopies, while 18 patients had intussusceptions as incidental findings. Intussusception length on CT as measured by radiologists O.E. and D.L. predicted acute bowel obstruction (p = .014 and p < .001). A 100 mm threshold predicted bowel obstruction with a sensitivity of 80% and 100% and a specificity of 93% and 86% by radiologists O.E. and D.L., respectively. Proximal bowel dilatation predicted SBOs of any cause as well as SBO caused by an intussusception (all p < .05). CONCLUSION Intussusception length > 100 mm on CT in RYGB patients is an easy and valuable sign indicating SBO that may require emergent surgery.
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Affiliation(s)
- Hassan Zaigham
- Department of Clinical Sciences, Malmö, Section of Surgery, Lund University, Skåne University Hospital, Malmö, Sweden.
| | - Mikael Ekelund
- Department of Clinical Sciences, Malmö, Section of Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Daisy Lee
- Department of Translational Medicine, Diagnostic Radiology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Olle Ekberg
- Department of Translational Medicine, Diagnostic Radiology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Sara Regnér
- Department of Clinical Sciences, Malmö, Section of Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
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10
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Iacobellis F, Dell’Aversano Orabona G, Brillantino A, Di Serafino M, Rengo A, Crivelli P, Romano L, Scaglione M. Common, Less Common, and Unexpected Complications after Bariatric Surgery: A Pictorial Essay. Diagnostics (Basel) 2022; 12:2637. [PMID: 36359480 PMCID: PMC9689585 DOI: 10.3390/diagnostics12112637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 06/27/2024] Open
Abstract
Bariatric surgery has demonstrated a higher rate of success than other nonsurgical treatments in selected patients with obesity; however, like all medical procedures, postoperative complications may occur, ranging between 2 and 10% and, although rare, they can be life threatening. Complications may be unspecific (any surgery-related complications) or specific (linked to the specific surgical procedure) and can be distinguished as common, less common, and unexpected. According to the onset, they may be acute, when occurring in the first 30 days after surgery, or chronic, with a presentation after 30 days from the procedure. The aim of this pictorial essay is to review the radiological aspects of surgical techniques usually performed and the possible complications, in order to make radiologists more confident with the postsurgical anatomy and with the normal and abnormal imaging findings.
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Affiliation(s)
- Francesca Iacobellis
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Naples, Italy
| | | | - Antonio Brillantino
- Department of Emergency Surgery, “A. Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Naples, Italy
| | - Marco Di Serafino
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Naples, Italy
| | - Alessandro Rengo
- Department of Radiology, Pineta Grande Hospital, Via Domitiana KM 30, 81030 Castel Volturno, Italy
| | - Paola Crivelli
- Department of Surgery, Medicine and Pharmacy, University of Sassari, Via Roma 151, 07100 Sassari, Italy
| | - Luigia Romano
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Naples, Italy
| | - Mariano Scaglione
- Department of Surgery, Medicine and Pharmacy, University of Sassari, Via Roma 151, 07100 Sassari, Italy
- Department of Radiology, The James Cook University Hospital, Middlesbrough TS4 3BW, UK
- School of Health and Life Sciences, Teesside University, Middlesbrough TS1 3BX, UK
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11
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Mezzacappa C, Hughes ML, Hung KW. An Uncommon Cause of Coffee Ground Emesis in a Young Woman With Remote Roux-en-Y Gastric Bypass. Gastroenterology 2022; 163:e16-e17. [PMID: 35490784 DOI: 10.1053/j.gastro.2022.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/07/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Catherine Mezzacappa
- Section of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Michelle L Hughes
- Section of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Kenneth W Hung
- Section of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
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12
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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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13
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Hu Q, Wu J, Sun Y. Intussusception Related to Small Intestinal Lipomas: A Case Report and Review of the Literature. Front Surg 2022; 9:915114. [PMID: 35846960 PMCID: PMC9280029 DOI: 10.3389/fsurg.2022.915114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/10/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Adult intussusception is a rare disease that is difficult to diagnose and treat and is even rarer when it is caused by a lipoma of the small intestine. We reported a case of a small intestine lipoma combined with intussusception, which can guide people in future clinical work. Case Presentation A 51-year-old female was admitted to the hospital with “abdominal pain for 1 month.” Enhanced computed tomography (CT) of the abdomen suggested a lipoma in the left lower quadrant and a proximal intussusception. After excluding surgical contraindications, laparoscopic exploration was performed on the second day of admission, which showed a small amount of ascites in the abdominal cavity, a small intestine–small intestine-type intussusception about 20 cm from the ileocecal area and about 140 cm from the ileocecal area, and a mass of about 2×4 cm that was palpable by laparoscopic intestinal forceps, which was protruded into the intestinal cavity with a soft texture and sound mobility. A 5 cm-long incision was made above the mass to dissect into the abdomen layer by layer, and the diseased intestine was dislodged outside the abdominal cavity with oval forceps. The intestine was reduced by hand and observed for half an hour after reduction, and the blood circulation and peristalsis of the intestine were observed to be still sound. The intestine was dissected at 2 cm from the upper and lower margins of the mass using linear anastomosis to operate small intestine side-to-side anastomosis. The intestine was opened concurrently and closed with a linear anastomosis, using 3-0 absorbable thread to reinforce anastomosis intermittently. The procedure went smoothly, and the patient was discharged on the 5th postoperative day. Conclusion A small intestinal lipoma combined with small intestinal intussusception is rare in clinical practice and needs to be diagnosed by asking history detailedly, physical examination, and relevant ancillary tests such as abdominal CT. Laparoscopic-assisted small incision surgery for adult intussusception combines the advantages of laparoscopic surgery and laparotomy, operating simply and easily.
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14
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Small Bowel Obstruction from Retrograde Intussusception of the Common Channel After Gastric Bypass: a Surgical Emergency. Obes Surg 2022; 32:1401-1402. [PMID: 35044601 DOI: 10.1007/s11695-022-05910-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/11/2022] [Accepted: 01/14/2022] [Indexed: 10/19/2022]
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15
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Facing the unexpected: unusual causes of mechanical small bowel obstruction in adults. Clin J Gastroenterol 2021; 14:1287-1302. [PMID: 34076858 DOI: 10.1007/s12328-021-01450-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/22/2021] [Indexed: 10/21/2022]
Abstract
Mechanical small bowel obstruction in adults is a common emergency condition that typically requires hospitalisation and usually acute surgical intervention. The majority of the cases are due to adhesive obstruction or common abdominal wall hernias or relevant related past history. However, the surgeons might face unexpected challenges in this concept due to rare causes of this condition. This paper explores in depth the challenges encountered by the emergency general surgeons in the concept of management of rare causes of mechanical small bowel obstruction in adults through a systematic review and critical analysis of the available evidence, and summarises the essential intra-operative steps that are needed to be taken accordingly. In conclusion, the emergency surgeons should be familiar with the uncommon/rare causes of mechanical small bowel obstruction in adults to avoid serious complications. Successful outcomes are based on the combination of high index of clinical suspicion, familiarity with the standard anatomy and its variations, the use of the appropriate radiological investigations and surgical intervention in a timely manner.
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