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RYGB-Induced Gut Dysmotility and Retrograde Intussusception: an Unusual Phenomenon. A Narrative Literature Review

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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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References

  1. Noncommunicable diseases: Risk factors [Internet]. [cited 2022 Apr 4]. Available from: https://www.who.int/data/gho/data/themes/topics/topic-details/GHO/ncd-risk-factors

  2. CDC - Page Not Found [Internet]. 2019 [cited 2022 Apr 4]. Available from: https://www.cdc.gov/404.html

  3. Welbourn R, Hollyman M, Kinsman R, Dixon J, Liem R, Ottosson J, et al. Bariatric surgery worldwide: baseline demographic description and one-year outcomes from the Fourth IFSO Global Registry Report 2018. Obes Surg. 2019;29(3):782–95.

    Article  Google Scholar 

  4. Daellenbach L, Suter M. Jejunojejunal intussusception after Roux-en-Y gastric bypass: a review. Obes Surg. 2011;21(2):253–63.

    Article  Google Scholar 

  5. 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 Off J Am Soc Bariatr Surg. 2008;4(1):69–72.

    Article  Google Scholar 

  6. Begos DG, Sandor A, Modlin IM. The diagnosis and management of adult intussusception. Am J Surg. 1997;173(2):88–94.

    Article  CAS  Google Scholar 

  7. Onopchenko A. Radiological diagnosis of internal hernia after Roux-en-Y gastric bypass. Obes Surg. 2005;15(5):606–11.

    Article  Google Scholar 

  8. Zainabadi K, Ramanathan R. Intussusception after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2007;17(12):1619–23.

    Article  Google Scholar 

  9. Lessmann J, Soto E, Merola S. Intussusception after Roux-en-Y gastric bypass for morbid obesity. Surg Obes Relat Dis. 2008;4(5):664–7.

    Article  Google Scholar 

  10. Kirshtein B, Roy-Shapira A, Lantsberg L, Avinoach E, Mizrahi S. Laparoscopic management of acute small bowel obstruction. Surg Endosc. 2005;19(4):464–7.

    Article  CAS  Google Scholar 

  11. Chou NH, Mok KT, Liu SI, Wang BW, Tsai CC, Chen IS, et al. Intestinal obstruction in patients with previous laparotomy for non-malignancy. J Chin Med Assoc. 2005;68(7):327–32.

    Article  Google Scholar 

  12. Hocking MP, McCoy DM, Vogel SB, Kaude JV, Sninsky CA. Antiperistaltic and isoperistaltic intussusception associated with abnormal motility after Roux-en-Y gastric bypass: a case report. Surgery. 1991;110(1):109–12.

    CAS  PubMed  Google Scholar 

  13. Nguyen TuB, Kelly KA. Motility disorders after Roux-en-Y gastrojejunostomy. Obes Surg. 1994;4(3):219–26.

    Article  Google Scholar 

  14. Edwards MA, Grinbaum R, Ellsmere J, Jones DB, Schneider BE. Intussusception after Roux-en-Y gastric bypass for morbid obesity: case report and literature review of rare complication. Surg Obes Relat Dis. 2006;2(4):483–9.

    Article  Google Scholar 

  15. Ver SK. Retrograde intussusception following Roux-en-Y gastric bypass. Obes Surg. 2006;16(8):1101–3.

    Article  Google Scholar 

  16. Stephenson D, Moon RC, Teixeira AF, Jawad MA. Intussusception after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2014;10(4):666–70.

    Article  Google Scholar 

  17. Orthopoulos G, Grant HM, Sharma P, Thompson E, Romanelli JR. S054: incidence and management of jejunojejunal intussusception after Roux-en-Y gastric bypass: a large case series. Surg Endosc. 2020;34(5):2204–10.

    Article  Google Scholar 

  18. Singla S, Guenthart BA, May L, Gaughan J, Meilahn JE. Intussusception after laparoscopic gastric bypass surgery: an underrecognized complication. Minim Invasive Surg. 2012;2012:464853.

    PubMed  PubMed Central  Google Scholar 

  19. Kohli A, Gutnik L, Berman D, Narula A. Jejunojejunostomy intussusception after gastric bypass: Case report of a rare but serious complication. Int J Surg Case Rep. 2017;30:101–2.

    Article  Google Scholar 

  20. Boudourakis LD, Divino C, Nguyen S. Retrograde intussusception seven years after a laparoscopic Roux-en-Y gastric bypass. J Minimal Access Surg. 2013;9(2):82–3.

    Article  Google Scholar 

  21. McAllister MS, Donoway T, Lucktong TA. Synchronous intussusceptions following Roux-en-Y Gastric Bypass: case report and review of the literature. Obes Surg. 2009;19(12):1719–23.

    Article  Google Scholar 

  22. Gohil BC, Sacks BC, Mccloskey C, Eid GM, Ramanathan RC. P81: Intussusception following laparoscopic Roux-en-Y gastric bypass surgery for morbid obesity. Surg Obes Relat Dis. 2006;2(3):336.

    Article  Google Scholar 

  23. Duane TM, Wohlgemuth S, Ruffin K. Intussusception after Roux-en-Y gastric bypass. Am Surg. 2000;66(1):82–4.

    Article  CAS  Google Scholar 

  24. Marcoe JP, Chau WY. Intussusception after open Roux-en-Y gastric bypass managed with laparoscopic reduction. J Surg Case Rep. 2021;2021(8):rjab339.

    Article  Google Scholar 

  25. Maggard MA, Yermilov I, Li Z, Maglione M, Newberry S, Suttorp M, et al. Pregnancy and fertility following bariatric surgery: a systematic review. JAMA. 2008;300(19):2286–96.

    Article  CAS  Google Scholar 

  26. 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(10):rjx189.

    Article  Google Scholar 

  27. Perdue PW, Johnson HW, Stafford PW. Intestinal obstruction complicating pregnancy. Am J Surg. 1992;164(4):384–8.

    Article  CAS  Google Scholar 

  28. 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 [Internet]. 2019 Dec 11 [cited 2022 Mar 28]; Available from: https://www.liebertpub.com/doi/abs/10.1089/bari.2019.0010

  29. Bokslag A, Jebbink J, Wit LD, Oudijk M, Ribbert L, Tahri S, et al. Intussusception during pregnancy after laparoscopic Roux-en-Y gastric bypass. Case Rep. 2014;2014:bcr2014205357.

    Google Scholar 

  30. Marinis A, Yiallourou A, Samanides L, Dafnios N, Anastasopoulos G, Vassiliou I, et al. Intussusception of the bowel in adults: a review. World J Gastroenterol. 2009;15(4):407–11.

    Article  Google Scholar 

  31. 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(5):1017–28.

    Article  Google Scholar 

  32. Davalos GG, Chen S, Portenier DD, Guerron DD, Jain-Spangler K. Intussusception post-Roux-en-Y gastric bypass: laparoscopic management compilation. Surg Obes Relat Dis. 2018;14(11):S83.

    Article  Google Scholar 

  33. 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 Off J Am Soc Bariatr Surg. 2008;4(2):77–83.

    Article  Google Scholar 

  34. Srikanth MS, Keskey T, Fox SR, Oh KH, Fox ER, Fox KM. Computed tomography patterns in small bowel obstruction after open distal gastric bypass. Obes Surg. 2004;14(6):811–22.

    Article  Google Scholar 

  35. Efthimiou E, Court O, Christou N. Small bowel obstruction due to retrograde intussusception after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2009;19(3):378–80.

    Article  Google Scholar 

  36. Chys B, Fierens J, Sohier S, Van Krunckelsven L, Dedrye L. Jejuno-Jejunal Intussusception after Roux-en-Y Gastric Bypass. Obes Surg. 2020;30(10):4155–8.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida, Morsani College of Medicine, 5 Tampa General Circle, Tampa, FL, 33606, USA

    Abdul-Rahman F. Diab, Joseph A. Sujka & Christopher G. DuCoin

  2. Department of Surgery, Houston Methodist, 6550 Fannin St., Houston, TX, 77030, USA

    Rodolfo J. Oviedo

  3. Department of Surgery, NYU Grossman School of Medicine, 8714 Fifth Avenue, Brooklyn, NY, 11209, USA

    Sharique Nazir

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  1. Abdul-Rahman F. Diab
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  2. Rodolfo J. Oviedo
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  3. Sharique Nazir
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  4. Joseph A. Sujka
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  5. Christopher G. DuCoin
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Correspondence to Abdul-Rahman F. Diab.

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Key points

• A total of 91.67% of cases were seen in females, 19.19% of which were obstetric cases (pregnant or postpartum).

• Intussusception was non-lead point induced, jejunojejunal, retrograde, originating from the common limb, and involving the jejunojejunal anastomosis in 98.33%, 94.6%, 87.36%, 86.08%, and 71.28% of cases, respectively.

• Management was reduction, resection, and both reduction and resection in 34.65%, 36.63%, and 23.76% of cases, respectively. Ischemia was seen in 41.67% of cases.

• In patients who underwent small bowel resection, 61.67% had a concomitant resection and reconstruction of the anastomosis.

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Diab, AR.F., Oviedo, R.J., Nazir, S. et al. RYGB-Induced Gut Dysmotility and Retrograde Intussusception: an Unusual Phenomenon. A Narrative Literature Review. OBES SURG 32, 3452–3457 (2022). https://doi.org/10.1007/s11695-022-06236-0

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