Computed Tomography Patterns in Small Bowel Obstruction after Open Distal Gastric Bypass

Srikanth, Myur S.; Keskey, Thomas; Fox, S Ross; Oh, Ki Hyun; Fox, Earl R.; Fox, Katherine

doi:10.1381/0960892041590971

Cited by 49 publications

(26 citation statements)

References 8 publications

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“…Look for a gastrogastric fistula/connection, surreptitious nonsteroidal anti-inflammatory drug (NSAID) use, or too large a proximal pouch. Intestinal obstructions can occur from internal hernias/obstructions where the Roux limb passes through the mesocolon, at the enteroenterostomy, or infracolically behind the Roux limb mesentery (Peterson's hernia) [5]. A specific obstruction that can present as nonproductive postprandial vomiting/ retching and epigastric bloating/pain is obstruction of the pancreatobiliary limb with dilation of the bypassed stomach and duodenum (rarely this will be an intussusception).…”

Section: Rygbmentioning

confidence: 99%

Reoperative bariatric surgery

Sarr

2007

Surg Endosc

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Section: Rygbmentioning

confidence: 99%

Reoperative bariatric surgery

Sarr

2007

Surg Endosc

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“…Labrunie and Marchiori 8 , Onopchenko 13 and Srikanth et al 14 consider CT imaging the method of choice for investigation of abdominal symptoms, especially …”

Section: Discussion Discussion Discussion Discussion Discussionmentioning

confidence: 99%

Achados tomográficos das alterações abdominais pós-operatórias dos pacientes submetidos ao derivação gastrojejunal em Y-de-Roux sem anel

Ribas

Nassif

Ribas

et al. 2012

Rev. Col. Bras. Cir.

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CT CT CT CT findings in patients submitted to findings in patients submitted to findings in patients submitted to findings in patients submitted to findings in patients submitted to Roux-en-y gastric bypass without ring Roux-en-y gastric bypass without ring Roux-en-y gastric bypass without ring Roux-en-y gastric bypass without ring Roux-en-y gastric bypass without ring Achados tomográficos das alterações abdominais pós-operatórias dos pacientes Achados tomográficos das alterações abdominais pós-operatórias dos pacientes Achados tomográficos das alterações abdominais pós-operatórias dos pacientes Achados tomográficos das alterações abdominais pós-operatórias dos pacientes Achados tomográficos das alterações abdominais pós-operatórias dos pacientes submetidos ao derivação gastrojejunal em Y-de-Roux sem anel submetidos ao derivação gastrojejunal em Y-de-Roux sem anel submetidos ao derivação gastrojejunal em Y-de-Roux sem anel submetidos ao derivação gastrojejunal em Y-de-Roux sem anel submetidos ao derivação gastrojejunal em Y-de-Roux sem anel FERNANDA We studied 40 CT exams from patients attended at the radiology service with the intention to clarify abdominal complains. The patients were in post-bariatric surgical follow-up and were operated in the same hospital. We excluded patients who had undergone bariatric surgery by other surgical techniques, operated by another surgical team and the ones who did not agree with the administration of oral or intravenous iodinated contrast media and exceeding the weight limit of the examination table. Results Results ResultsResults Results: The patients were aged from 23 to 70 years, 11 male and 29 female. There were no extra-abdominal changes, and 30 of the 40 patients had CT findings within normal limits. The presence of stenosis at the gastrojejunal anastomosis was found in one patient, internal hernias occurred in five, anastomotic leak in one and the presence of abscess occurred in three of patients. ConclusionConclusion Conclusion Conclusion Conclusion: Total abdominal CT failed to inform the cause of the symptoms in 87.5% of patients seeking medical re-evaluation for symptoms of post-operative bariatric surgery. Due to the need for more effective intervention in the clinical management of severe obesity, the indications for bariatric operations have been growing 5 . The surgical treatment for severe obesity has been employed for nearly half a century. It began in the 1950s with operations that caused malabsorption, abandoned in the late 1970s due to their serious side effects. From then on, procedures that limit food intake began to dominate, either by simply restricting the capacity of the stomach, or by its division and anastomosis to the proximal jejunum 6 . Among the surgical techniques currently considered for treatment of morbid obesity, Roux-en-Y gastric bypass is widely used 2,6,7 . With the increase in the frequency of bariatric operations, it is necessary that the radiologist must be aware The postoperative radiological study, the survey of complications an...

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“…Contrast-enhanced axial CT is diagnostic in most cases and often proves instrumental in providing timely intervention. The characteristic "target sign" is pathognomonic for intussusception and a sausageshaped mass in the region of the jejunojejunostomy may be seen on sagittal reconstructed images [21]. One may also see a dilated excluded stomach consistent with an obstructed biliopancreatic limb [21].…”

Section: Discussionmentioning

confidence: 99%

“…The characteristic "target sign" is pathognomonic for intussusception and a sausageshaped mass in the region of the jejunojejunostomy may be seen on sagittal reconstructed images [21]. One may also see a dilated excluded stomach consistent with an obstructed biliopancreatic limb [21]. High clinical suspicion for complete obstruction, however, should prompt immediate exploration without delay for radiologic studies.…”

Section: Discussionmentioning

confidence: 99%

Synchronous Intussusceptions Following Roux-en-Y Gastric Bypass: Case Report and Review of the Literature

2009

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Intussusception is an atypical cause of small bowel obstruction following Roux-en-Y gastric bypass and, as such, is not often considered in the differential diagnosis. In this setting, the pathophysiology appears to differ in that a pathologic lead point is rarely identified and the intussusceptum most often progresses retrograde into the proximal bowel. Involvement of the jejunojejunostomy is nearly universal in reported cases and, if untreated, can lead to devastating consequences. Despite this potential, the clinical presentation often lacks remarkable features yet timely surgical intervention is generally required. This phenomenon is being reported with greater frequency and altered motility in the Roux limb is the prevailing hypothesis regarding pathogenesis. Awareness of the potential for this process and prompt consultation with a bariatric surgeon are keys to optimal outcomes.

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Computed Tomography Patterns in Small Bowel Obstruction after Open Distal Gastric Bypass

Cited by 49 publications

References 8 publications

Reoperative bariatric surgery

Reoperative bariatric surgery

Achados tomográficos das alterações abdominais pós-operatórias dos pacientes submetidos ao derivação gastrojejunal em Y-de-Roux sem anel

Synchronous Intussusceptions Following Roux-en-Y Gastric Bypass: Case Report and Review of the Literature

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