Obesity Surgery

, Volume 20, Issue 12, pp 1740–1742

Late Intestinal Obstruction due to an Intestinal Volvulus in a Pregnant Patient with a Previous Roux-en-Y Gastric Bypass

  • Anajara Gazzalle
  • Débora Braun
  • Leandro Totti Cavazzola
  • Luiz Roberto Wendt
  • Daniel Navarini
  • Marcelo de Azevedo Fauri
  • Santo Pascual Vitola
Case Report

Abstract

This is a case of a 33 weeks pregnant woman, presented 2 years after laparoscopic Roux-en-Y gastric bypass, with abdominal pain for 2 days. A laparoscopic cholecystectomy was performed 1 day earlier in another hospital, without improving the pain. She presented at our hospital with acute abdominal pain and clinical signs of intestinal obstruction, undergoing an exploratory laparotomy that revealed a volvulus and necrosis of the jejunum from the gastroenteroanastomosis through the lateral enteroenterostomy, which was resected with the reconstruction of the Roux-en-Y limb performed at the same operation. Patient and neonate presented with improvement after surgery and the patient was discharged on postoperative day 15. Internal hernias after bariatric surgery have been reported as the cause of acute abdomen problems during pregnancy, which may progress to necrosis and perforation. The delay of surgical intervention could have brought a tragic outcome for mother and neonate.

Keywords

Bariatric surgery Complications Pregnancy Postoperative Intestinal obstruction Volvulus 

References

  1. 1.
    Paroz A, Calmes JM, Giusti V, et al. Internal hernia after laparoscopic Roux-en-Y gastric bypass for morbid obesity: a continuous challenge in bariatric surgery. Obes Surg. 2006;16:1482–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Koppmann JS, Li C, Gandsas A. Small bowel obstruction after laparoscopic Roux-en-Y gastric bypass: a review of 9527 patients. J Am Coll Surg. 2008;3:571–84.CrossRefGoogle Scholar
  3. 3.
    Nelson LG, Gonzales R, Haines K, et al. Spectrum and treatment of small bowel obstruction after Rounx-en-Y gastric bypass. SOARD. 2006;2:377–83.Google Scholar
  4. 4.
    Merkle EM, Hallowel PT, Crouse C, et al. Roux-en-Y gastric bypass for clinically severe obesity: normal appearance and spectrum of complications at imaging. Radiology. 2005;234:674–83.CrossRefPubMedGoogle Scholar
  5. 5.
    Rogula T, Yenumula PR, Schauer PR. A complication of Roux-en-Y gastric bypass: intestinal obstruction. Surg Endosc. 2007;21:1914–8. Epub 2007 Sep 22.CrossRefPubMedGoogle Scholar
  6. 6.
    Higa KD, Ho T, Boone KB. Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment and prevention. Obes Surg. 2003;13:350–4.CrossRefPubMedGoogle Scholar
  7. 7.
    Kakarla N, Dailey C, Marino T, et al. Pregnancy after gastric bypass surgery and internal hernia formation. Obstet Gynecol. 2005;105:1195–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Champion JK, Williams M. Small bowel obstruction and internal hernias after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2003;13:596–600.CrossRefPubMedGoogle Scholar
  9. 9.
    Husain S, Ahmed AR, Johnson J, et al. Small-bowel obstruction after laparoscopic Roux-en-Y gastric bypass: etiology, diagnosis, and management. Arch Surg. 2007;142:988–93.CrossRefPubMedGoogle Scholar
  10. 10.
    Garza E Jr, Kuhn J, Arnold D, et al. Small-bowel obstruction after laparoscopic Roux-en-Y gastric bypass: etiology, diagnosis, and management. Am J Surg. 2004;188:796–800.CrossRefPubMedGoogle Scholar
  11. 11.
    Loar PV 3rd, Sanchez-Ramos L, Kaunitz AM, et al. Maternal death caused by midgut volvulus after bariatric surgery. Am J Obstet Gynecol. 2005;193:1748–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Capella RF, Iannace VA, Capella JF. Bowel obstruction after open and laparoscopic gastric bypass surgery for morbid obesity. J Am Coll Surg. 2006;203:328–35.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2009

Authors and Affiliations

  • Anajara Gazzalle
    • 1
  • Débora Braun
    • 2
  • Leandro Totti Cavazzola
    • 1
    • 3
  • Luiz Roberto Wendt
    • 1
  • Daniel Navarini
    • 1
  • Marcelo de Azevedo Fauri
    • 1
  • Santo Pascual Vitola
    • 1
  1. 1.General Surgery Service, Hospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do Sul (Federal University of Rio Grande do Sul)Porto AlegreBrazil
  2. 2.Universidade Luterana do BrasilCanoasBrazil
  3. 3.Porto AlegreBrazil

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