Biography

We present the case of a forty seven year old female with class two obesity (body mass index 37), type two diabetes, and gastroesophageal reflux who was found to have a congenital intestinal malrotation at the time of a laparoscopic omega loop Roux-en-Y gastric bypass (RYGB). Following creation of the gastric pouch, the ligament of Treitz was not identified in the typical anatomic location. Further abdominal exploration confirmed the diagnosis of congenital intestinal malrotation. A laparoscopic Ladd’s procedure was then performed in order to prevent future gastrointestinal obstruction and permit completion of the RYGB. After finishing the Ladd’s procedure, we proceeded with the gastrointestinal reconstruction in a Roux-en-Y fashion. We contrast how the abnormal anatomy in the setting of congenital malrotation (with the jejunum originating in the right upper quadrant) affects gastrointestinal reconstruction when compared to a typical omega loop RYGB. Our patient was discharged on post operative day 2 and did not experience any postoperative complications. At her 6 month follow up visit she demonstrated a 55 pound weight loss (41.3% total body weight loss, 23.5% excess body weight loss) with resolution of her type two diabetes.