Unexpected Biliopancreatic Limb Obstruction after Gastric Bypass Revision
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Unexpected Biliopancreatic Limb Obstruction after Gastric Bypass Revision Anand Patel 1,2 & Chih-Kun Huang 1,3
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Introduction Biliopancreatic limb obstruction is a surgical emergency in patients who have undergone gastric bypass surgery. This case report presents an unexpected cause of biliopancreatic limb obstruction and the importance of prompt intervention. Material and Methods A 37-year-old woman presented with complaints of weight regain (BMI increased from 27 to 33.3 kg/m2) and bile reflux and was found to have marginal ulcers on endoscopy. She had undergone loop gastric bypass with Braun anastomosis in 2009 at another center for morbid obesity (BMI = 43 kg/m2). Roux-en-Y gastric bypass (RYGB) was created after the separation of gastro-jejunostomy (GJ) and jejuno-jejunostomy (JJ). On the fifth postoperative day, the patient was readmitted with signs of peritonitis. Urgent relaparoscopy showed Biliopancreatic limb (BP) obstruction. It was then and that we understood intraoperatively the uncut Roux-en-Y caused stricture between the previous GJ and JJ staple lines. Side-to-side jejuno-jejunostomy between the proximal dilated and the distal collapsed biliopancreatic limb was performed. Result The patient recovered uneventfully and was discharged after drain removal. Conclusion Biliopancreatic limb obstruction requires prompt decision for relaparoscopy. Timely intervention is necessary to prevent postoperative morbidity. Reviewing the operative video or notes of the primary surgery can minimize the chance of mismanagement during revision surgery. Keywords Biliopancreatic limb obstruction . Uncut Roux-en-Y . Gastrojejunostomy . Roux-en-Y gastric bypass . One anastomosis gastric bypass
Introduction This manuscript is neither published nor under consideration for publication in any other journal. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11695-020-04431-5) contains supplementary material, which is available to authorized users. * Chih-Kun Huang [email protected]
Biliopancreatic limb obstruction is a surgical emergency in patients who have undergone gastric bypass surgery. Internal herniation and adhesions or narrowing at the anastomotic site are commonly cited reasons for bowel obstruction [1]. This case report presents an unexpected cause of biliopancreatic limb obstruction and the importance of prompt intervention.
Anand Patel [email protected] 1
Body Science and Metabolic disorders International Medical Center, China Medical University Hospital, Yude Rd., North Dist, Taichung, Taiwan
2
Department of Gastrointestinal Surgery, Zydus Hospital, Ahmedabad, India
3
China Medical University, Yude Rd., North Dist, Taichung, Taiwan
Material and Methods A 37-year-old woman presented with complaints of weight regain (BMI increased from 27 to 33.3 kg/m2) and bile reflux and was found to have marginal ulcers on endoscopy. She had undergone loop gastric bypas
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