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Case Report
Small bowel intussusception after Roux-en-Y gastric bypass: A case report
1 General Surgery Resident, General Surgery Department, Hospital do Espírito Santo de Évora, EPE, Évora, Portugal
2 General Surgery Consultant, General Surgery Department, Hospital do Espírito Santo de Évora, EPE, Évora, Portugal
3 Head of Department of General Surgery, General Surgery Department, Hospital do Espírito Santo de Évora, EPE, Évora, Portugal
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Joana Oliveira
Hospital do Espírito Santo de Évora, EPE, Largo do Senhor da Pobreza, 7000-811 Évora,
Portugal
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Article ID: 100117Z06JO2023
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How to cite this article
Oliveira J, Bolota J, Lima R, Velez C, Amaro M, Carvalho M. Small bowel intussusception after Roux-en-Y gastric bypass: A case report. Case Rep Int 2023;12(1):23–28.ABSTRACT
Introduction: Small bowel intussusception after Rouxen-Y gastric bypass is a rare condition, with a reported incidence of 0.07–0.6%, and a multifactorial etiology. The severity of the condition ranges from small bowel edema to ischemia and perforation with peritonitis, and the clinical presentation and blood tests are non-specific. The computed tomography (CT) scan is the best diagnostic tool in an emergency department context.
Case Report: The authors present the case of a 41-year-old male patient, with history of Roux-en-Y gastric bypass two years before, who presented in the emergency department with acute onset abdominal pain and nausea. Abdominal exploration showed a tender mass in the left upper quadrant. Blood tests showed an increase in alanine transaminase (ALT) and aspartate transaminase (AST) and abdominal CT scan was compatible with a small bowel intussusception, without other findings. A diagnostic laparoscopy confirmed the diagnosis, and the intussusception was resolved without need of bowel resection. The patient showed no complications in the immediate post-operative period, with clinical and analytical improvement, and was discharged on the sixth post-operative day, without relevant complaints in the follow-up appointments.
Conclusion: Due to the non-specific clinical presentation of small bowel intussusception, it is required a high level of suspicion in patients who underwent gastric bypass and present with abdominal pain. In terms of surgical approach, resolution of the intussusception may be enough in many cases, when there is no vascular compromise of the bowel, while the evidence of ischemia requires bowel resection.
Keywords: Obesity surgery, Roux-en-Y gastric bypass, Small bowel intussusception
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Acknowledgments
The authors would like to thank Artur Silva, MD, Ânia Laranjeira, MD, Arnaldo Machado, MD, and Margarida Cinza, MD for their contribution to this paper.
Author ContributionsJoana Oliveira - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Joana Bolota - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Rita Lima - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Cristina Velez - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Margarida Amaro - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Manuel Carvalho - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2023 Joana Oliveira et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
