Skip to main content

Small Bowel Obstruction and Internal Hernias during Pregnancy after Gastric Bypass Surgery

Abstract

Small bowel obstruction (SBO) is a recognized complication of Roux-en-Y gastric bypass (RYGB) surgery. Internal hernia (IH) a potential problem associated with RYGB, can have severe consequences if not diagnosed. We present two cases of SBO due to IH during pregnancy after laparoscopic RYGB (LRYGB). Both patients underwent an antecolic, antegastric LRYGB. In both patients a Petersen’s type IH was found. We reviewed the cases reported in the literature of SBO during pregnancy after RYGB. IH should always be ruled out in pregnant patients with previous RYGB and abdominal pain. Prompt surgical intervention is mandatory for a good outcome.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 2006;295(13):1549–55.

    CAS  Article  Google Scholar 

  2. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004;292(14):1724–37.

    CAS  Article  Google Scholar 

  3. Pope GD, Birkmeyer JD, Finlayson SR. National trends in utilization and in-hospital outcomes of bariatric surgery. J Gastrointest Surg 2002;6(6):855–60. discussion 861.

    Article  Google Scholar 

  4. Marceau P, Kaufman D, Biron S, et al. Outcome of pregnancies after biliopancreatic diversion. Obes Surg 2004;14(3):318–24.

    Article  Google Scholar 

  5. Blachar A, Federle MP, Dodson SF. Internal hernia: clinical and imaging findings in 17 patients with emphasis on CT criteria. Radiology 2001;218(1):68–74.

    CAS  Article  Google Scholar 

  6. Champion JK, Williams M. Small bowel obstruction and internal hernias after laparoscopic Roux-en-Y gastric bypass. Obes Surg 2003;13(4):596–600.

    Article  Google Scholar 

  7. Garza E Jr., Kuhn J, Arnold D, et al. Internal hernias after laparoscopic Roux-en-Y gastric bypass. Am J Surg 2004;188(6):796–800.

    Article  Google Scholar 

  8. Fobi MA, Lee H, Holness R, et al. Gastric bypass operation for obesity. World J Surg 1998;22(9):925–35.

    CAS  Article  Google Scholar 

  9. Podnos YD, Jimenez JC, Wilson SE, et al. Complications after laparoscopic gastric bypass: a review of 3464 cases. Arch Surg 2003;138(9):957–61.

    Article  Google Scholar 

  10. Nguyen NT, Huerta S, Gelfand D, et al. Bowel obstruction after laparoscopic Roux-en-Y gastric bypass. Obes Surg 2004;14(2):190–6.

    Article  Google Scholar 

  11. Higa KD, Boone KB, Ho T. Complications of the laparoscopic Roux-en-Y gastric bypass: 1,040 patients—what have we learned? Obes Surg 2000;10(6):509–13.

    CAS  Article  Google Scholar 

  12. Schauer PR, Ikramuddin S, Gourash W, et al. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 2000;232(4):515–29.

    CAS  Article  Google Scholar 

  13. Charles A, Domingo S, Goldfadden A, et al. Small bowel ischemia after Roux-en-Y gastric bypass complicated by pregnancy: a case report. Am Surg 2005;71(3):231–4.

    PubMed  Google Scholar 

  14. Moore KA, Ouyang DW, Whang EE. Maternal and fetal deaths after gastric bypass surgery for morbid obesity. N Engl J Med 2004;351(7):721–2.

    CAS  Article  Google Scholar 

  15. Filip JE, Mattar SG, Bowers SP, et al. Internal hernia formation after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Am Surg 2002;68(7):640–3.

    PubMed  Google Scholar 

  16. Higa KD, Ho T, Boone KB. Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment and prevention. Obes Surg 2003;13(3):350–4.

    Article  Google Scholar 

  17. Felsher J, Brodsky J, Brody F. Small bowel obstruction after laparoscopic Roux-en-Y gastric bypass. Surgery 2003;134(3):501–5.

    Article  Google Scholar 

  18. Garrard CL, Clements RH, Nanney L, et al. Adhesion formation is reduced after laparoscopic surgery. Surg Endosc 1999;13(1):10–3.

    CAS  Article  Google Scholar 

  19. Ahmed AR, Rickards G, Husain S, et al. Trends in internal hernia incidence after laparoscopic Roux-en-Y gastric bypass. Obes Surg 2007;17(12):1563–6.

    Article  Google Scholar 

  20. Davis MR, Bohon CJ. Intestinal obstruction in pregnancy. Clin Obstet Gynecol 1983;26(4):832–42.

    CAS  Article  Google Scholar 

  21. Sheiner E, Levy A, Silverberg D, et al. Pregnancy after bariatric surgery is not associated with adverse perinatal outcome. Am J Obstet Gynecol 2004;190(5):1335–40.

    Article  Google Scholar 

  22. Baker MT, Kothari SN. Successful surgical treatment of a pregnancy-induced Petersen’s hernia after laparoscopic gastric bypass. Surg Obes Relat Dis 2005;1(5):506–8.

    Article  Google Scholar 

  23. Birchard KR, Brown MA, Hyslop WB, et al. MRI of acute abdominal and pelvic pain in pregnant patients. AJR Am J Roentgenol 2005;184(2):452–8.

    Article  Google Scholar 

  24. Singh A, Danrad R, Hahn PF, et al. MR imaging of the acute abdomen and pelvis: acute appendicitis and beyond. Radiographics 2007;27(5):1419–31.

    Article  Google Scholar 

  25. McCollough CH, Schueler BA, Atwell TD, et al. Radiation exposure and pregnancy: when should we be concerned? Radiographics 2007;27(4):909–17. discussion 917–8.

    Article  Google Scholar 

  26. Yumi H. Guidelines for diagnosis, treatment, and use of laparoscopy for surgical problems during pregnancy: This statement was reviewed and approved by the Board of Governors of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), September 2007. It was prepared by the SAGES Guidelines Committee. Surg Endosc 2008.

  27. Esmailzadeh H, Powell W, Lourie D. Use of computed tomography in diagnosis of major postoperative gastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery. Am Surg 2004;70(11):964–6.

    PubMed  Google Scholar 

  28. Blachar A, Federle MP, Pealer KM, et al. Gastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery: clinical and imaging findings. Radiology 2002;223(3):625–32.

    Article  Google Scholar 

  29. Bellanger DE, Ruiz JF, Solar K. Small bowel obstruction complicating pregnancy after laparoscopic gastric bypass. Surg Obes Relat Dis 2006;2(4):490–2.

    Article  Google Scholar 

  30. Kakarla N, Dailey C, Marino T, et al. Pregnancy after gastric bypass surgery and internal hernia formation. Obstet Gynecol 2005;105(5 Pt 2):1195–8.

    Article  Google Scholar 

  31. Ahmed AR, O’Malley W. Internal hernia with Roux loop obstruction during pregnancy after gastric bypass surgery. Obes Surg 2006;16(9):1246–8.

    Article  Google Scholar 

  32. Wang CB, Hsieh CC, Chen CH, et al. Strangulation of upper jejunum in subsequent pregnancy following gastric bypass surgery. Taiwan J Obstet Gynecol 2007;46(3):267–71.

    CAS  Article  Google Scholar 

  33. Al-Fozan H, Tulandi T. Safety and risks of laparoscopy in pregnancy. Curr Opin Obstet Gynecol 2002;14(4):375–9.

    Article  Google Scholar 

  34. Clark SL, Cotton DB, Pivarnik JM, et al. Position change and central hemodynamic profile during normal third-trimester pregnancy and post partum. Am J Obstet Gynecol 1991;164(3):883–7.

    CAS  Article  Google Scholar 

  35. ACOG Committee Opinion. Number 299, September 2004 (replaces No. 158, September 1995). Guidelines for diagnostic imaging during pregnancy. Obstet Gynecol 2004;104(3):647–51.

    Article  Google Scholar 

  36. Connolly MM, Unti JA, Nora PF. Bowel obstruction in pregnancy. Surg Clin North Am 1995;75(1):101–13.

    CAS  Article  Google Scholar 

  37. 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(5):1748–1749.

    Article  Google Scholar 

Download references

Acknowledgments

We thank Kimberly Pierce for her contributions with the illustrations.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Todd A. Kellogg.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Torres-Villalobos, G.M., Kellogg, T.A., Leslie, D.B. et al. Small Bowel Obstruction and Internal Hernias during Pregnancy after Gastric Bypass Surgery. OBES SURG 19, 944–950 (2009). https://doi.org/10.1007/s11695-008-9681-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-008-9681-x

Keywords

  • Gastric bypass
  • Internal hernia
  • Pregnancy
  • Bariatric surgery
  • Laparoscopic
  • Morbid obesity
  • Small bowel obstruction