Background

Gastric bypass is the standard procedure for weight reduction. Small bowel obstruction following gastric bypass can be secondary to many reasons. However, Small Bowel Intussusception is a rare complication. It requires a high index of suspicion, a prompt diagnosis, and surgical treatment.

Methods

Our patient is a 43-year-old female with a past medical history of morbid obesity who underwent laparoscopic Roux-en-y gastric bypass three years prior to her presentation to the ED. She presented with severe generalized abdominal pain for one day with multiple episodes of vomiting.On clinical exam, her abdomen was distended with generalized tenderness. Her labs showed elevated lactic acid. CT abdomen showed small bowel obstruction secondary to intussusception at the jejunojejunostomy anastomosis with areas of questionable ischemia. The patient was taken for a diagnostic laparoscopy which showed the common alimentary limb to be intussuscepted into the biliopancreatic limb. The bowel was successfully reduced, and it was only congested. There were no masses and the anastomosis looked unremarkable apart from being stretched, so it was not revised. Instead, multiple sutures were taken to anchor the biliopancreatic limb to the Roux limb and to tighten the anastomosis.The patient was discharged home by postoperative day 2. CT was repeated 30 days later, and it was unremarkable.

Conclusions

Small Bowel Intussusception even though is rare, should be considered as a cause of small bowel obstruction after Roux-en-y gastric bypass and needs immediate surgical intervention to prevent small bowel infarction. However, revision of anastomosis is not always necessary.