A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional
Issue link: https://bariatrictimes.epubxp.com/i/651228
12 Case Report Bariatric Times • March 2016 S urgical evaluation is essential as volvulus may lead to small bowel ischemia and subsequent necrosis if not treated. Definitive diagnosis must be determined intra-operatively. It is i mportant to note that a volvulus may not be apparent at the time of operation; it may resolve and recur, thus leading to a delay in diagnosis. For this reason, we believe a jejuno- j ejunostomy volvulus to be an under- diagnosed cause of abdominal pain following gastric bypass, even after exploration, and should be included on the differential of this patient p opulation. If discovered or strongly suspected during exploration, resection of the jejuno-jejunostomy with small bowel reconstruction should be considered as the definitive treatment. REFERENCES 1. Ogden CL, Carrol MD, Kit BK, Flegal K. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA. 2014; 311(8):806–814. 2. Mechanick JI, Youdim A, Jones DB, Garvey WT et al. Clinical Practice Guidelines for Perioperative Nutritional, M etabolic and Nonsurgical Support of the Bariatric Surgery Patient - 2013 Update. Obesity. 2013;21:/S1-S27. 3 . Angrisani L, Santonicola A, Lovino P, Formisano G, Buchwald H, Scopinaro N. Bariatric Surgery Worldwide 2013. Obes Surg. 2015;25(10):1822–1832. 4. Podnos YD, Jimenez JC, Wilson SE, Stevens CM, Nguyen NT. Complications after laparoscopic gastric bypass. A review of 3464 cases. Arch Surg. 2003;138:957–961. 5. Blachar A, Federle MP, Pealer KM, Ikramuddin S, Schauer PR. Gastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery: clinical and imaging findings. Radiology. 2002;223(3):625–632. 6. Abell TL, Minocha A. Gastrointestinal complications of bariatric surgery: d iagnosis and therapy. Am J Med Sci. 2006;331:214–218. 7 . Griffith PS, Birch DW, Sharma AM, Karmali S. Managing complications associated with laparoscopic Roux-en-Y Gastric bypass for morbid obesity. Can J Surg. 2012;55(5):329–336. 8. Higa K, Ho T, Boone KB. Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment, and prevention. Obes Surg. 2003;13:350–354. 9. Husain S, Ahmed AR, Johnson J, Boss T, O'Malley W. Small-bowel obstruction after laparoscopic Roux-en-Y gastric bypass: etiology, diagnosis, and management. Arch Surg. 2007;142(10):988–993. 10. Martin MJ, Beekley AC, Sebesta JA. B owel obstruction in bariatric and nonbariatric patients: major differences in management strategies and outcome. Surg Obes Relat Dis. 2011;7:263–270. 11. Champion JK, Williams M. Small bowel obstruction and internal hernias after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2003;13:596–600. 12. Cho M, Carrodeguas L, Pinto D, et al. Diagnosis and management of partial bowel obstruction after laparoscopic antecolic antegastric Roux-en-Y gastric bypass for morbid obesity. J Am Coll Surg. 2006;202(2);262–268. 13. Garrard CL, Clements RH, Nanney L, Davidson JM, Richardson WO. Adhesion formation is reduced after laparoscopic s urgery. Surg Endosc. 1999;13(1):10–13. 14. Gazzalle A, Braun, D, Cavazzola LT, et al. Late intestinal obstruction due to an intestinal volvulus in a pregnant patient with a previous Roux-en-Y gastric bypass. Obes Surg. 2010;20:1740–1742. 15. Ng M, Toribio R, Sugiyama, G. Rare case of concurrent intussusception and volvulus after Roux-en-Y gastric bypass for morbid obesity. J Sur Cas Rep. 2013;2013(1). 16. Daellenbach L, Suter M. Jejunojejunal intussusception after Roux-en-Y gastric bypass: a review. Obes Surg. 2011;21:253–263. 17. Gonzalez-Pezzat I, Soto-Perez-de-Celis E, Pantoja-Millan JP. Late perforation and abscess formation at the site of the jejunojejunal anastomosis following laparoscopic Roux-en-Y gastric bypass surgery. Obes Surg. 2009;19:661–663. DISCLAIMER: The views expressed herein are our own and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. Government FUNDING: No funding was provided. DISCLOSURES: The authors report no conflicts relevant to the content of this article. AUTHOR AFFILIATION: 2 nd LT Solomon Tong, MS, is from Uniformed Services University of Health Sciences, Bethesda Maryland. LCDR Jesse Bandle, MD, is Assistant Professor of Surgery, Uniformed Services University of the Health Sciences/F. Edward Hebert School of Medicine in Bethesda, Maryland. Dr. Bandle is also from U.S. Naval Hospital Okinawa, Japan. CDR Gordon G. Wisbach, MD, MBA, is Assistant Professor of Surgery, Uniformed Services University of the Health Sciences/F. Edward Hebert School of Medicine in Bethesda, Maryland. Dr. Wisbach is also from Naval Medical Center San Diego in San Diego, California. ADDRESS FOR CORRESPONDENCE: Gordon G. Wisbach, MD, MBA; E-mail: gwisbach@gmail.com