Background

Diagnosing the etiology of acute abdomen in a postoperative bariatric patient can be a challenge. This video presentation describes a patient that underwent a robotic Roux en Y gastric bypass and postoperatively developed abdominal pain and sustained tachycardia and returned to the OR for exploration. After negative air insufflation leak test of the gastrojejunostomy and jejunojejunostomy, indocyanine green was utilized intraluminal via laparoscopic assisted endoscopy and demonstrated a JJ anastomotic leak. The JJ was redone and the patient did well postoperatively. ICG can be a useful adjunct for detection of anastomotic leak in bariatric surgery.

Methods

This case describes a 59 year old with obesity who underwent robotic assisted RYGB. Postoperatively, the patient developed sustained tachycardia and worsening abdominal pain. CT imaging with PE evaluation was inconclusive for a source. The patient was returned to the OR. There was no significant free fluid. The gastrojejunal anastomosis appeared intact. The JJ anastomosis appeared inflamed with roux limb dilation. Given suspicious appearance of the JJ, this area was focused on and further evaluation performed. On upper endoscopy, fluid and solid material was noted with distention of the roux limb, but no obvious perforation seen. Air was insufflated via endoscopy for a leak test of the anastomoses and was negative. Next, ICG was instilled proximal to the JJ via endoscopy; extraluminal extravasation was detected of the anterior aspect. The JJ was resected and a new JJ created. The patient progressed well and was discharged home 1 week from reoperation.