Intussusception as a complication of bariatric surgery in pregnant patients: report of one case and revision of the literature

Boccalatte, Luis Alejandro; Rodríguez, J.A. Carnerero; Beskow, Axel; Cavadas, Demetrio; Wright, Fernando

doi:10.1093/jscr/rjx189

Cited by 13 publications

(13 citation statements)

References 9 publications

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“…Não se pode dizer com clareza que a gravidez pode aumentar o risco de intussuscepção intestinal, mas uma redução de peso acentuada aumenta a chances de torção e intussuscepção intestinal². Estudos indicam que a maior incidência ocorre após quatro anos do procedimento cirúrgico 1 . No caso relatado, a paciente apresentava um período de nove anos da cirurgia de by-pass gástrico, corroborando a hipótese.…”

Section: Discussionunclassified

Intussuscepção intestinal em gestante pós by-pass gástrico: relato de caso

Trevisane

Ferrari

Stefano

et al. 2021

Medicina (Ribeirão Preto)

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Em todo o mundo, estima-se que aproximadamente 634.897 pessoas são submetidas a procedimentos bariátricos a cada ano, com gastrectomia vertical e by-pass gástrico, representando 53,6% e 30%, respectivamente. Entre pacientes operados, aproximadamente metade são mulheres em idade reprodutiva. Em adultos, a intussuscepção é tipicamente devida a um local patológico no intestino, que pode ser maligno em mais da metade dos casos. A intussuscepção intestinal é rara em adultos, representando 1 a 5% das obstruções intestinais mecânicas. A intussuscepção em gestantes pós by-pass gástrico é uma patologia muito rara de origem desconhecida com alto poder de lesão e injúria de órgãos e sistemas. Suas manifestações clínicas são como abdômen agudo obstrutivo, porém, na paciente gestante dificulta o diagnóstico precoce. Este relato de caso apresenta uma paciente de 38 anos, gestante de 22 semanas, com quadro de dor abdominal de forte intensidade acompanhada de vômitos em grande quantidade há um dia, antecedente de by-pass gástrico há quatro anos. O diagnóstico do quadro de intussuscepção intestinal foi possível após o sétimo dia de internação com auxílio de exame de imagem - RNM, sendo indicado o tratamento cirúrgico para correção do caso. Evoluiu com choque séptico com necessidade de internação prolongada em leito de CTI, recebendo alta após 27 dias de internação.

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Section: Discussionunclassified

Intussuscepção intestinal em gestante pós by-pass gástrico: relato de caso

Trevisane

Ferrari

Stefano

et al. 2021

Medicina (Ribeirão Preto)

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“…There is a case report of intussusception after 7 years postbariatric surgery 2. Only a few cases of acute small bowel obstruction in an RYGB complicating pregnancy has been described in medical literature 3 4. The aetiology of postbariatric intussusception, is mostly unknown.…”

Section: Discussionmentioning

confidence: 99%

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

Bhadra¹,

Somasundaram

Nowak

et al. 2018

BMJ Case Rep

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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.

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“…Over the last few years, more studies have become available regarding acute small bowel obstruction during pregnancy due to internal herniation or intussusception, especially after Roux-en-Y gastric bypass (RYGB). [9][10][11][12][13][14] The diagnosis of these acute abdominal bariatric complications during pregnancy can be challenging because the clinical presentation might be similar to general pregnancy-related complaints and imaging techniques lack high sensitivity, specificity, or availability. 13 Furthermore, the incidence is low, whereas expertise is needed for adequate clinical decision-making.…”

Section: Introductionmentioning

confidence: 99%

“…[9][10][11][12][13][14] The diagnosis of these acute abdominal bariatric complications during pregnancy can be challenging because the clinical presentation might be similar to general pregnancy-related complaints and imaging techniques lack high sensitivity, specificity, or availability. 13 Furthermore, the incidence is low, whereas expertise is needed for adequate clinical decision-making. [11][12][13] Related to the increase in evidence of pregnancy-related risks after BS, various guideline articles with recommendations regarding the care of pregnant women after BS have recently been published.…”

Section: Introductionmentioning

confidence: 99%

“…13 Furthermore, the incidence is low, whereas expertise is needed for adequate clinical decision-making. [11][12][13] Related to the increase in evidence of pregnancy-related risks after BS, various guideline articles with recommendations regarding the care of pregnant women after BS have recently been published. 15,16 Recommendations are, among others, to postpone a pregnancy after BS for 12-24 months so that maternal weight has been stabilized, to prescribe specific supplementation during the preconception and periconception period, and to avoid excessive gestational weight gain.…”

Section: Introductionmentioning

confidence: 99%

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Pregnancy and Bariatric Surgery: Significant Variation in Bariatric Surgeons' Practices and Preferences: A National Survey

Bonouvrie

Taverne

Janssen

et al. 2022

Bariatric Surgical Practice and Patient Care

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Background: Bariatric complications may occur during pregnancy, potentially causing serious maternal and fetal problems. The aim of this study was to determine the current practice and preferences of bariatric surgeons regarding the pregnancy care of fertile women before and after bariatric surgery. Methods: A 26-question anonymous online survey was designed and sent to all bariatric surgeons of the Dutch Society of Metabolic and Bariatric Surgery.Results: At least one bariatric surgeon from each bariatric center (n = 18) completed the survey. In case of a future child, wish sleeve gastrectomy became more popular than Roux-en-Y gastric bypass. All surgeons provided preoperative education regarding bariatric complications during pregnancy. Nine centers without neonatal intensive care would not refer pregnant women with acute complications. Half of the centers had a standard operating procedure. Seven per 18 bariatric centers had seen at least one postbariatric pregnant patient with severe maternal morbidity. One case of perinatal mortality was reported. Conclusion: There is an inconsistent and often below guideline standard daily practice regarding pregnancy before and after bariatric surgery. There is limited experience with pregnant women with acute bariatric complications. Referral to tertiary centers is inadequate. Better information provision for both professionals and patients regarding possible complications is needed.

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Intussusception as a complication of bariatric surgery in pregnant patients: report of one case and revision of the literature

Cited by 13 publications

References 9 publications

Intussuscepção intestinal em gestante pós by-pass gástrico: relato de caso

Intussuscepção intestinal em gestante pós by-pass gástrico: relato de caso

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

Pregnancy and Bariatric Surgery: Significant Variation in Bariatric Surgeons' Practices and Preferences: A National Survey

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