Case Report: an Unusual Complex Internal Hernia After Roux-en-Y Gastric Bypass
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LETTER TO THE EDITOR
Case Report: an Unusual Complex Internal Hernia After Roux-en-Y Gastric Bypass Xuejing Zheng 1 & Jianlu Zhang 1 & Liang Wang 1 & Qing Sang 1 & Bin Zhu 1 & Nengwei Zhang 1
&
Zhipeng Sun 1
Received: 7 October 2020 / Revised: 13 October 2020 / Accepted: 13 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Introduction
Patient and Methods
Roux-en-Y gastric bypass (RYGB) has been proved to be an effective procedure for morbid obesity and metabolic disorders [1–3]. The complications associated with RYGB include bleeding, anastomotic ulcer, anastomotic leakage, anastomotic stricture, intestinal obstruction, and malnutrition [4–6]. Bowel obstruction is a relatively common postoperative complication following the RYGB procedure. The main causes of obstruction are internal hernias through Peterson’s or mesenteric defect and anastomotic stenosis [7]. Complete intestinal obstruction is rare but results in severe complications after RYGB. Emergency operation is warranted when complete, strangulated internal hernia leading to intestinal obstruction has been diagnosed. Here, we presented a case of intestinal obstruction secondary to an unusual complex internal hernia combined with jejuno-jejunal stricture, presented at several years after RYGB. In addition, we highlighted the three specific clinical signs and tricks in the operative approach of managing such disorder.
In 2012, a 35-year-old woman (BMI, 32 kg/m2; weight, 90 kg) underwent RYGB in our center for morbid obesity and metabolic syndrome. Five years later, in 2017, she presented with vomiting intermittently and was diagnosed with chronic, incomplete intestinal obstruction secondary to an anastomotic stricture. Her symptoms were resolved following conservative management. However, in July 2019, she presented to the emergency room of our center with persistent abdominal pain. After a history taking, physical, and an urgent CT scan, she was diagnosed with complete intestinal obstruction caused by an internal hernia and intestinal volvulus. After failing conservative treatment, laparoscopic exploration was performed. During the operation, dilated biliopancreatic limb, obvious mesenteric hernia, and stricture of the jejuno-jejunal anastomosis were observed. We proceeded to create a small enterotomy on the biliopancreatic limb to decompress this dilated loop. The decompression had helped in reducing the mesenteric hernia. However, there were lots of intestines that were incarcerated, with the hernia content and the hernia ring
Xuejing Zheng, Jianlu Zhang and Liang Wang contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11695-020-05060-8) contains supplementary material, which is available to authorized users. * Nengwei Zhang [email protected]
Qing Sang [email protected]
* Zhipeng Sun [email protected]
Bin Zhu [email protected]
Xuejing Zheng [email protected] Jianlu Zhang [email protected] Liang Wang [email protected]
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