Background

Duodenal switch (DS) is well known as the most effective and durable bariatric procedure in terms of weight loss and resolution of comorbidities. We present an uncommon complication in a patient with history of laparoscopic Roux-en-Y Gastric Bypass (RYGB) converted to open DS.

Methods

A 51-year-old malnourished female with history of laparoscopic RYGB in 2000 converted to open DS in 2006 presented with one day of severe abdominal pain, nausea, and vomiting. CT A/P revealed likely internal hernia with dilated jejunal loop. Exploratory laparotomy revealed volvulus of jejunoileal anastomosis with edematous bowel. Reduction of volvulus was performed and TPN was started postoperatively. Patient was discharged on POD7 but returned two days later with diffuse abdominal pain and belching. CT A/P revealed intussusception of distal anastomosis. We then revised the anastomosis by moving the biliopancreatic limb proximally to increase common channel length.

Results

Incidence of intussusception after RYGB is as low as 0.62% but literature on DS is limited. Despite improved weight loss compared to RYGB, DS patients have increased perioperative complications especially in those with hypoalbuminemia as with our patient. Importantly, anastomotic revision and lengthening of the common channel was performed only after resolution of bowel edema and improvement of malnutrition to reduce risk of leak

Conclusions

Intussusception is a rare but life-threatening complication of RYGB converted to DS. Revision of the distal anastomosis and lengthening of the common channel may improve surgical outcomes after addressing malnutrition and waiting for bowel edema and thickening to resolve.