Intussusception after Laparoscopic Gastric Bypass Surgery: An Underrecognized Complication

Abstract

Introduction. Intussusception after bariatric surgery is an uncommon complication that is now being frequently reported. Most people consider dysmotility to be the causative mechanism in the absence of obvious etiology. Material and Methods. A worldwide search identified literature describing intussusception after bariatric surgery. We also included our own patients and analyzed information regarding demographic profile, risk factors, presentation, diagnosis, and post treatment course. Results. Seventy one patients were identified between 1991 and 2011. Majority of the affected patients were females (n = 70, 98.6%); median time to presentation after gastric bypass surgery was 36 months. Most patients presented with abdominal pain, nausea and vomiting, but without obvious peritonitis. Sixty eight patients (96%) required surgery; 48 (70.6%) underwent revision of anastomosis, 16 (23.5%) had reduction without resection, while 4 patients (5.9%) had plication only. Amongst these, most patients (n = 51, 75%) were found to have retrograde intussusception. Post-operatively, 9 patients presented with recurrence (range, 0.5–32 months). Five patients, who had earlier been treated without resection, eventually required revision of the anastomosis. There was no mortality noted. Conclusion. Intussusception after bariatric surgery is uncommon and its diagnosis is based on a combination of physicial, radiological and operative findings. An early surgical intervention reduces morbidity and prevents recurrence.

Intussusception during pregnancy after laparoscopic Roux-en-Y gastric bypass

“…After LRYGB, 0.1–0.3% of the patients will get an intussusception 6. Intussusception in pregnancy is rare, it accounts for 5% of all intestinal obstructions during pregnancy 5.…”

“…In order to assess the imaging properly, it is important to inform the radiologist about the anatomical situation after LRYGB. If there is still a suspicion of intussusception, a CT scan is the best modality to demonstrate intussusception 6. Radiation exposure to fetus and mother should be considered carefully, balanced against the condition of the mother.…”

Spontaneous reduction of intussusception in gastric bypass patient: A case report and review of literature

“…The largest review consisting of 71 patients, in which intussusception is found to be more common among female patients (98.6%) and most presented with abdominal pain and vomiting. Of these patients, 96% of patients required surgery, 70.6% of whom required anastomotic revision and 23.5% underwent reduction without resection [18].However, cases of spontaneous reduction in post gastric bypass patients presenting with intussusception is rarely found. The review focused on 23 patients with gastric bypass and presented with intussusception, 9 of the patients were found to have spontaneous reduction, although some were reduced while running the bowel intraoperatively.…”

Intussusception during pregnancy of a gastric bypass patient

“…A recent article retrospectively identified 71 patients with intussusception after laparoscopic gastric bypass [5].…”