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Ileal bezoar causing bowel obstruction mimicking an internal hernia in a patient with Roux-en-Y gastric bypass

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Abstract

We presented a case of a 64-year-old female patient with a history of gastric bypass that presented with bowel obstruction due to a bezoar. She arrived at the emergency department, referring to severe abdominal pain, nausea, and vomiting. Abdominal X-ray reported gastric distention and hydro-air levels. CT scan reported swirling of the mesentery vessels and a collapsed intestinal loop, mimicking an internal hernia. Laparotomy was accomplished, which shows obstruction at 60 cm from the ileocecal valve. An enterolithotomy was performed, and a 6 × 6 cm phytobezoar was extracted. The patient had a satisfactory postoperative outcome, discharging her home on the fourth postoperative day. On a 12 month-follow up, the patient is doing well with no further complications. Gastric bypass continues to be one of the most performed bariatric procedures with low complication rates. It is important to note that not all intestinal obstructions in postoperative bariatric surgeries are due to internal hernias or adhesions. The differential diagnosis of intestinal obstruction due to bezoar must be present in patients who underwent bariatric surgery. Nutritional counseling is essential for the follow-up of patients, emphasizing fluid intake and slow chewing, as well as the use of absorbable materials for suture during the surgery.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Dr. Ignacio Morones Prieto O 3000, 64710, Monterrey, Mexico

    Carlos Antonio Morales-Morales, Mauricio Gonzalez-Urquijo, Roberto Agustín Rumbaut-Díaz, Horacio Javier Guajardo-Pérez & Mario Rodarte-Shade

  2. Especialidades Bariátricas, Avenida de la Industria 300, Torre C, Oficina 8, Punto Central, 66279, San Pedro Garza García, Mexico

    Roberto Agustín Rumbaut-Díaz & Horacio Javier Guajardo-Pérez

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  1. Carlos Antonio Morales-Morales
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  2. Mauricio Gonzalez-Urquijo
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  3. Roberto Agustín Rumbaut-Díaz
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  4. Horacio Javier Guajardo-Pérez
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  5. Mario Rodarte-Shade
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Correspondence to Mauricio Gonzalez-Urquijo.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of Tecnologico de Monterrey ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.

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Morales-Morales, C.A., Gonzalez-Urquijo, M., Rumbaut-Díaz, R.A. et al. Ileal bezoar causing bowel obstruction mimicking an internal hernia in a patient with Roux-en-Y gastric bypass. Clin J Gastroenterol 13, 1111–1115 (2020). https://doi.org/10.1007/s12328-020-01183-8

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  • DOI: https://doi.org/10.1007/s12328-020-01183-8

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