A near-fatal case of intussusception and ischaemic perforation of stomach in first-trimester pregnancy: eight years after laparoscopic Roux-en-Y gastric bypass

Abstract

The increasing demand and popularity of bariatric surgery are not only due to the ever-increasing obesity epidemic but to tackle obesity-related comorbidities like diabetes and hypertension. However, bariatric surgery is not free of complications. One rare complication is intussusception, jejuno-jejunal intussusception being the most common. Intussusception has been defined both in pregnant and in non-pregnant women as well as men. We describe the case of a 40-year-old woman in the first trimester of pregnancy came to the hospital with worsening abdominal pain, was found to have intussusception of small bowel involving the jejunum, along with ischaemic perforation and necrosis of the fundus of the stomach. Postsurgery, the patient had a complete recovery and eventually, she successfully delivered an intact, viable fetus.

Retrograde intussusception post-total gastrectomy and small bowel resection with Roux-en-Y gastric bypass reconstruction

“…Abdominal CT is considered the most sensitive, reliable and useful way of diagnosing intussusception with a reported accuracy of 58-100% [10]. MRI abdomen/pelvis is recommended in pregnant women to limit radiation exposure [11,12].…”

“…Most intussusceptions occur in antegrade fashion, however, with RYGB, the intussusception is more often retrograde in nature [1,4,11,12]. All three limbs of the Roux-en-Y anastomosis can be affected by intussusception, however in most cases published so far it has been the common channel that has invaginated through the jejuno-jejunostomy [5].…”

Intussusception and Gut Dysmotility: A Systematic Review Assessing Unexpected Complications of Bariatric Surgery

“…Doño et al reported a case where a patient presented with symptoms 32 years after undergoing open RYGB [ 11 ]. Bhadra et al reported symptoms emerging nine years after surgery, while Chys et al indicated a variation of 9-11 years between presentation and surgery [ 12 , 13 ]. Conversely, Michiels et al presented a case with a comparatively shorter gap of two years between surgery and symptom manifestation [ 14 ].…”

“…Doño et al reported that the patient presented with worsening abdominal pain with pain radiation to the flank: 10/10 on the pain scale associated with nausea and constipation[11]. Bhadra et al's report showcased a patient with 10/10 worsening abdominal pain with nausea and episodes of frank blood vomiting[12]. According to Teixeira et al, the patient reported having nausea, vomiting, intermittent stomach pain, distension of the abdomen, and no feces or flatus[15].Machado et al reported a patient with symptoms of abdominal pain and nonbilious vomiting, whereas Facchiano et al reported a patient with abdominal pain, bilious vomiting, and fever…”