Intussusception after laparoscopic Roux-en-Y gastric bypass

Intussusception and Gut Dysmotility: A Systematic Review Assessing Unexpected Complications of Bariatric Surgery

Bariatric surgery, although effective in treating obesity-related comorbidities, rarely results in intussusception, which is a severe complication. This study aimed to enhance clinical practice and establish early diagnosis by elucidating risk factors and management strategies associated with intussusception. We conducted this systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 criteria. We looked through PubMed, PubMed Central, ScienceDirect, ScienceOpen, MyScienceWork, Hyper Articles en Ligne (HAL), Google Scholar, and the Medical Literature Analysis and Retrieval System Online for relevant studies and research. Articles were screened according to inclusion and exclusion criteria, and relevance. We employed pertinent quality appraisal instruments to look for bias. Initially, we discovered 2,833 items. We eliminated redundant and unnecessary publications. After reviewing all the articles, we selected 30 studies based on their titles and abstracts. Out of the 30 studies reviewed, 12 papers were included in this review, with the remaining 18 being eliminated due to low quality. Medical practitioners and surgeons have a responsibility to meticulously monitor and provide postoperative surveillance, with a particular emphasis placed on individuals exhibiting symptoms of abdominal pain and vomiting, as there is a clinical imperative to consider the possibility of intussusception. The management approach, whether conservative or surgical, remains contingent upon the clinical context.

Unique long-term simultaneous complications of conventional Roux-en-Y gastric bypass after 27 years: A case report

INTRODUCTION

We report a case of late concomitant complications caused by conventional Roux-en-Y gastric bypaas and its managements.

PRESENTATION OF CASE

A 62-year-old male presented 27 years after conventional gastric bypass Y-de-Roux (BGYR) with, sudden, moderate intensity abdominal pain, nausea, biliary vomiting and hyporexia. Persistent abdominal pain was constant, so a thoracoabdominal tomography was requested by the surgeon. It confirmed the presence of intestinal intussusception associated with lithiasis and cholecystitis. The patient reported having lost 45 kg since the BGYR. He goes to the operating room for definitive management.

DISCUSSION

The etiology of post-BGYR intussusception is largely unknown, and multiple hypotheses have been created, such as the iatrogenic stitch created by the suture line in the entero-enteric anastomosis and the most common pattern found is antegrade. The use of contrasted CT as the most reliable diagnostic method.

CONCLUSION

The importance of taking into account the possible complications existing in bariatric patients and their frequency gives us the opportunity to suspect and detect them in time and in the most cases the management must be surgical.

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.

Anterograde jejunojejunal intussusception through the distal anastomosis as complication after Roux-en-Y gastric bypass

Introduction: Small bowel intussusception is a rare complication after Roux-en-Y gastric bypass (RYGB) whose incidence tends to increase. This rising could be explained by an increasing bariatric surgery over the last two decades and by a better recognition of this potential complication. Patient and methods: We report a case of jejunojejunal intussusception in 33-year-old woman 2 years following a laparoscopic RYGB. She was taken to the operating room for exploratory laparotomy. Results: Its diagnosis is based on a combination of physical, radiological, and operative findings. The surgical exploration confirmed an anterograde jejunojejunal intussusception through the Roux-en-Y anastomosis. A lead point was not identified. We performed the resection of the blind extremity of the biliopancreatic limb to prevent recurrence. Conclusions: Small bowel intussusception is a rare long-term complication after RYGB. The underlying causative mechanism remains unclear. This rare condition may cause obstruction and lead to bowel necrosis if not recognized and treated promptly.

A near-fatal case of intussusception and ischaemic perforation of stomach in first-trimester pregnancy: eight years after laparoscopic Roux-en-Y gastric bypass

The increasing demand and popularity of bariatric surgery are not only due to the ever-increasing obesity epidemic but to tackle obesity-related comorbidities like diabetes and hypertension. However, bariatric surgery is not free of complications. One rare complication is intussusception, jejuno-jejunal intussusception being the most common. Intussusception has been defined both in pregnant and in non-pregnant women as well as men. We describe the case of a 40-year-old woman in the first trimester of pregnancy came to the hospital with worsening abdominal pain, was found to have intussusception of small bowel involving the jejunum, along with ischaemic perforation and necrosis of the fundus of the stomach. Postsurgery, the patient had a complete recovery and eventually, she successfully delivered an intact, viable fetus.

Retrograde jejunojejunal intussusception in a pregnant female after laparoscopic Roux-en-Y gastric bypass

Adult intussusception is a rare complication after laparoscopic Roux-En-Y gastric bypass (LRYGB) surgery. Incidence of intussusception is on the rise as the demand of bariatric surgeries is increased to treat morbid obesity. Among the bariatric surgeries, LRYGB gastric bypass results in significantly higher weight loss with thinning of the mesentery resulting in increased risk for intussusception. Majority of intussusception cases after gastric bypass have been reported in non-pregnant patients. We report a case of retrograde jejunojejunal intussusception in 6 weeks pregnant female following laparoscopic gastric bypass, which was diagnosed with abdominal magnetic resonance imaging and managed successfully with resection and revision of the anastomosis.

Retrograde intussusception seven years after a laparoscopic Roux-en-Y gastric bypass

Intussusception after Roux-en-Y gastric bypass is more common than previously believed. It usually occurs between one and three years post-operatively, though we present a case that presented with a retrograde intussusception necessitating bowel resection seven years after a laparoscpic Roux-en-Y gastric bypass. The diagnosis and etiological theories are discussed based on findings from the literature.

Jejunojejunal intussusception after Roux-en-Y gastric bypass: a review

Small bowel intussusception is a rare long-term complication after Roux-en-Y gastric bypass, the etiology of which remains unclear. Except for one series reporting on 23 patients, case reports represent the vast majority of all cases reported so far. With this complete review of the world literature, based on a total of 63 patients including 2 of our own cases, we provide an extensive overview of the subject. The origin of intussusception after gastric bypass is different from that of intussusception of other causes, in that there is usually no lead point. It is likely related to motility disorders in the divided small bowel, especially in the Roux limb. This rare condition may cause obstruction and lead to bowel necrosis if not recognized and treated promptly. Clinical presentation is not specific. Computerized tomography scan represents the diagnostic test of choice, but surgery is sometimes the only way to establish the diagnosis. Treatment may be limited to reduction if the small bowel is viable, but resection of the affected segment is recommended on the basis of this review, since it seems to result in fewer recurrences. Knowledge of this entity and a high index of suspicion are required to make the correct diagnosis and offer appropriate treatment in a timely fashion.