Background

We present the case of a 45-year-old female with a known history of Roux-en-Y gastric bypass in 2019 who underwent revisional surgery in 2023 for a perforated marginal ulcer. She presented with a 24-hour history of intense paroxysmal abdominal pain and emesis, with a CT scan showing a target sign and small bowel dilatation, suggesting jejuno-jejunostomy intussusception which prompted us to offer revisional reconstruction of the JJ. We started the procedure by identifying the ileocecal valve and running the limbs proximally towards the JJ. We identified the intussusception just distal to the JJ. Since we were not able to reduce the intussusception laparoscopically, we proceeded to transect the common channel distal to the intussusception. We then transected the Roux Limb and Biliopancreatic limb to liberate the specimen for removal. At this point, we proceeded with the JJ reconstruction by performing a side to side stapled anastomosis between the transected distal tip of the roux limb and the common channel. Then, we performed the second anastomosis between the biliopancreatic limb and the roux limb-common channel complex to restablish intestinal continuity. The patient did really well postoperatively and was discharged on POD 4. At her next follow-up, she reported complete resolution of her abdominal pain, no complications, and regular bowel movements.