Retrograde intussusception seven years after a laparoscopic Roux-en-Y gastric bypass
The patient was a 43-year-old African American female who presented to the emergency room with paroxysmal, severe abdominal pain as well as nausea and vomiting that began soon after a large meal. She denied melena or recent change in bowel habits. She reported losing approximately 100 lbs since her laparoscopic, retrocolic RYGBP. On examination, the patient was well nourished, afebrile, and with normal vital signs. She was in moderate distress with pain out of proportion to the physical examination. Her abdomen was soft, and there were no signs of peritoneal irritation or distension. Laboratory data were unremarkable. Computed tomography scan revealed high-grade small bowel obstruction adjacent to the jejuno-jejunal anastamosis with dilation of the biliopancreatic limb and the gastrojejunal limb []. This obstruction was associated with a loop of small intestine which had telescoped into itself, consistent with intussusception. The patient was immediately taken to the operating room.\nVisualization of the abdomen under pneumoperitoneum revealed massively dilated small bowel necessitating conversion to an open procedure. There was an area of intussuscepted bowel just past the small bowel anastomosis of the gastric bypass. Approximately six inches of distal small bowel had telescoped in a retrograde fashion towards the anastomosis []. The intussusception was reduced with great difficulty. The region of telescoped small bowel was non-viable and resected. A leadpoint was not identified. Of note, there was a Petersen defect identified and closed; there was no incarcerated bowel within the defect. Examination of the remaining abdominal cavity was unremarkable. Pathologic analysis of the specimen revealed a segment of small bowel that was focally hemorrhagic and necrotic.\nThe patient had an unremarkable post-operative course and was discharged on post-operative day five. Follow-up after 24 months has been without complication.