IBC Oxford University Oral Abstract 2 - Small bowel obstruction due to intraluminal clot (haemobezoar) following laparoscopic gastric bypass—different clinical approaches to a rare complication of bariatric surgery—a case series from a tertiary hospi

Abstract Introduction The incidence of small bowel obstruction (SBO) after Roux-en-Y gastric bypass (RYGB) ranges from 0.6% to 3.5%, with common causes being surgical adhesions, internal hernias, and anastomotic stenosis. Intraluminal clots causing obstruction are rare. A PubMed search for ‘small bowel obstruction’ AND (‘haemobezoar’ OR ‘intraluminal clot’ OR ‘blood clot’) identified 27 cases reported between 2005 and 2024. This study presents three cases of SBO due to intraluminal clots at the jejuno-jejunostomy in patients who underwent laparoscopic RYGB. Methods A retrospective analysis was conducted on three patients who experienced SBO caused by an intraluminal clot after laparoscopic RYGB performed by the CRI-O group. Of 2117 laparoscopic RYGB performed between 2019–2023, 47 (2.22%) had post-operative bleeding and 5 (0.24%) had post-operative SBO. Baseline demographic, preoperative, and intraoperative factors among patients with and without early postoperative bleeding were analysed. Data on preoperative conditions, symptoms, diagnostic methods, and treatment outcomes were collected of each case. The primary outcome was to detail the clinical presentation and management of SBO caused by intraluminal clots. Results Three female patients, with a mean BMI of 41.9 kg/m2 and a mean age of 43 years, presented with SBO due to intraluminal clots located at the jejuno-jejunostomy within the first two postoperative days. Symptoms included haematemesis, haematochezia, nausea, vomiting, and abdominal pain, with tachycardia being the most frequent clinical sign. All patients required blood transfusions and were diagnosed using CT scans with intravenous contrast. Surgical intervention varied: two patients underwent emergency surgery due to haemorrhagic shock, involving decompression of the gastric remnant and clot removal, although with different approaches. One patient, hemodynamically stable, was managed conservatively. Conclusion SBO caused by intraluminal clots post-RYGB is a rare, but serious complication. Early symptoms include signs of gastrointestinal bleeding and intestinal obstruction, with tachycardia being a frequent indicator. Haemodynamic instability necessitates urgent surgical intervention to prevent severe outcomes like ischemia and septic shock. Conservative management can be effective in hemodynamically stable patients. This case series highlights the importance of prompt diagnosis and individualized treatment strategies for SBO caused by intraluminal clots post-RYGB.