Jejuno-Jejunal Intussusception after Roux-en-Y Gastric Bypass
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Jejuno-Jejunal Intussusception after Roux-en-Y Gastric Bypass Brecht Chys 1,2
&
Johan Fierens 1 & Stefan Sohier 1 & Ludo Van Krunckelsven 1 & Lieven Dedrye 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020, corrected publication 2020
Abstract Introduction Roux-en-Y gastric bypass is the most common bariatric procedure in Belgium. Retrograde intussusception is identified as a rare late complication. Methods Here we present two cases of retrograde jejuno-jejunal intussusception after Roux-en-Y gastric bypass. Results Women who experienced excellent weight loss appear most prone. Although ectopic pacemaking is suggested, the exact pathophysiologic mechanism remains unclear. Simple manual reduction seems to be insufficient as treatment. Lowest recurrence rates are noted after segmentectomy. Conclusion Retrograde intussusception is a rare late complication after RYGB which is becoming more and more relevant due to increasing procedure volumes. Retrograde peristalsis by ectopic pacemakers could be identified as a cause. Segmentectomy appears to be the best treatment of choice. Keywords RYGB . Bariatric . Intussusception . Surgery
Introduction Roux-en-Y gastric bypass (RYGB) excels as the most common procedure in Belgium for morbid obesity. In 2016, the Belgian federal knowledge center for healthcare (KCE) recorded 13,382 The original version of this article was revised to correct the author names. Chys Brecht, Fierens Johan, Sohier Stefan and Van Krunckelsven Ludo contributed equally to this work. Lieven, Dedrye is a Contributing and senior author * Brecht Chys [email protected]; [email protected]
bariatric surgeries, 8402 (62.8%) of which were RYGB deviations [1]. Retrograde intussusception (RIS) is one of the rare late complications following RYGB. Intussusception is defined by the telescoping of a segment of the gastrointestinal tract within the lumen of the adjacent segment. Classically antegrade, it is considered to be a rare etiology of obstruction in adults. The estimated incidence can be as low as one in a million per year [2]. Intussusception following RYGB occurs almost exclusively at the jejuno-jejunostomy (J-J) site in a retrograde fashion [2, 3]. Females who experienced good weight loss, e.g., interval drop in body mass index (BMI) of 15.8 kg/m2, seem to be more prone [2]. Literature is scarce causing ideal management to be obscure. The best choice of treatment remains controversial to date. Here we present two cases of RIS after RYGB.
Johan Fierens [email protected] Stefan Sohier [email protected] Ludo Van Krunckelsven [email protected] Lieven Dedrye [email protected] 1
Department of abdominal surgery, Jan Yperman Hospital, Ypres, Belgium
2
Urology, Department of Development and Regeneration, University Hospitals Leuven, Leuven, Belgium
Cases Our first case is that of a 56-year-old female who presented at the emergency department due to severe subcostal pain on the left side which she developed abruptly ove
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