Intussusception in pregnancy after gastric bypass: a case report

Successful Vaginal Delivery during Acute Small Bowel Obstruction: A Case Report and Review of the Literature

Small bowel obstruction during pregnancy is rare and can be detrimental to both mother and fetus. In most cases, management eventually involves surgical intervention. Little is known regarding optimal mode of delivery in those with bowel obstruction during pregnancy. We present a case of vaginal delivery during acute small bowel obstruction as well as a review of recent literature regarding mode of delivery in the setting of bowel obstruction. Our case and literature review demonstrates that in pregnancies complicated by small bowel obstruction, successful vaginal delivery can be achieved in those with stable maternal-fetal status.

Incidence and treatment of intussusception following Roux-en-Y gastric bypass: a systematic review and meta-analysis

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.

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

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.

Management of surgical complications of previous bariatric surgery in pregnant women. A systematic review from the BARIA-MAT Study Group

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.