BS SO18 - Small bowel intussusception after Roux-en-Y gastric bypass: A case report and review of literature

Abstract Background Small bowel obstruction after RYGB for obesity can occur due to various common causes like internal hernia and adhesions. One of the rare complications of RYGB is retrograde intussusception of jejunum at the common channel. Since it does not present with typical symptoms of small bowel obstruction, it is often challenging to consider it as differential diagnosis at initial presentation. Also, managing the intussusception at non bariatric centres could prove difficult due to location of it in the common channel, which will require understanding of orientation of alimentary and biliary limbs as well as reconstruction after resection of the intussusception. Method We collected the details of our patients admission episode from a different centre where she was admitted initially to understand the clinical behaviour of the condition. Also, we conducted a systematic search of literature databases like PubMed, Embase, CINAHL, ProQuest Dissertations & Theses using MeSH terms and keywords Intussusception, Retrograde intussusception, J-J intussusception, Intestinal Obstruction, Small bowel obstruction, Bowel obstruction, Obesity, Morbid obesity, Gastric Bypass, Roux-en-Y gastric bypass, Jejunojejunostomy, Jejuno-jejunostomy, Gastric by-pass, RYGB, Roux-en-Y. Data were extracted on to Excel sheet for analysis. Results The search yielded 41 case reports. Patients were operated in most instances except in seven cases where they had multiple episodes. The average age of presentation was 38 mostly in females and few instances being during pregnancy including our patient. Intussusception happened between 5 to 360 months after the initial operation with the average time after the operation being 66 months. Pain was the principal mode of presentation without classical symptoms of bowel obstruction. There were few instances of coffee ground vomiting. CT was the diagnostic modality in almost all cases. Recurrence was invariable when not managed with resection. Conclusion Small bowel intussusception after RYGB occurs retrogradely and does not present with classical symptoms and signs of small bowel obstruction. It can be reliably diagnosed with CT abdomen. Of note, medical management and no-resectional surgical management results in recurrence of this condition.