Rare case of concurrent intussusception and volvulus after Roux-en-Y gastric bypass for morbid obesity
A 43-year-old woman [body mass index (BMI) 27.4 kg/m2] with a past medical history of morbid obesity (BMI 53.1 kg/m2) had progressively worsening upper abdominal pain and distention with associated bilious vomiting. She also reported constipation for 1 week.\nHer past surgical history included a laparoscopic Roux-en-Y gastric gastrojejunostomy (LRYGB) and cholecystectomy 7 years ago. The bypass procedure was complicated 2 years later by SBO secondary to an internal hernia, which required exploratory laparotomy and repair. Four years after her LRYGB, a ventral hernia developed, which was repaired laparoscopically with mesh.\nOn examination, her abdomen was soft and distended with upper abdominal tenderness. No peritoneal signs were present. An upright abdominal X-ray demonstrated dilated loops of small bowel with air-fluid levels suggestive of SBO. Subsequent contrast-enhanced computed tomography (CT) of the abdomen and pelvis showed dilated loops of small bowel with evidence of strangulation and a mesenteric whirl sign converging at a suture line (Fig. ).\nAn emergent laparotomy was performed. Intraoperative assessment revealed an infarcted volvulus segment of small bowel with twisted mesentery and proximal obstruction. The infarcted segment included the jejunojejunostomy suture line, which was resected and reconstructed. The surgical specimen demonstrated intussusception of small bowel with extensive mucosal necrosis. The patient had an unremarkable post-operative course and was discharged to home.