Selwan D Barbat, MD, Abdelrahman A Nimeri, MD, FACS, FASMBS, Timothy S Kuwada, MD, FACS, FASMBS, Keith S Gersin, MD, FACS, FASMBS. Carolinas Weight Management & Wellness Center
Background: Intussusception after Roux-en-Y gastric bypass is a rare, but critical event that has an incidence of 0.1 to 0.3%. There have been only a few case series published, with no clear consensus of the appropriate treatment for this rare complication. This video shows the approach to intussusception after gastric bypass for one patient at our institution.
Case Presentation: The patient is a 34 year old female who presented with intussusception after gastric bypass two years prior to presentation. CT imaging was displayed, along with the laparoscopic approach the surgeon takes in treating this patient. The video begins with explaining the port site placement and the importance of visualizing the inframesocolic region. The bowel is followed from the terminal ileum until the intussusception is seen proximal to the jejunojejunostomy anastomosis, in a retrograde fashion. This was reduced. The potential defects at the jejunojejunostomy anastamosis and the gastrojejunostomy anastamosis were evaluated without hernias appreciated. The decision was made to not perform an enteropexy or resection of the jejunojejunostomy anastamosis. The patient tolerated the procedure well postoperatively. She was discharged and seen on a 3 week follow-up visit without recurrence of symptoms. She is the fifth patient with an intussusception after gastric bypass that our institution has treated with simple reduction. There have been no recurrences at this time.
Conclusion: Intussusception after gastric bypass is a rare event that often presents in a retrograde fashion, dissimilar to other cases of intussusception in the general population. A few case reports have been published with different treatment techniques; including simple reduction, enteropexy, or resection and revision of the jejunojejunostomy anastomosis. Our institution has treated five patients with simple reduction with no recurrences. Our institution advocates simple reduction as an appropriate treatment option for intussusception after gastric bypass.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94221
Program Number: V048
Presentation Session: Bariatric I – Complications
Presentation Type: Video