Internal herniation during pregnancy after banded Roux-en-Y gastric bypass: a unique location

2020 ◽  
Vol 13 (12) ◽  
pp. e236798
Author(s):  
Daniëlle Susan Bonouvrie ◽  
Evert-Jan Boerma ◽  
Francois M H van Dielen ◽  
Wouter K G Leclercq
Keyword(s):  
Gastric Bypass ◽  
Small Bowel ◽  
Neonatal Intensive Care ◽  
Postoperative Recovery ◽  
Internal Herniation ◽  
Referral Centre ◽  
Mri Scan ◽  
Tertiary Referral Centre ◽  
Bariatric Complications ◽  
History Of

A 26-year-old multigravida, 30+3 weeks pregnant woman, was referred to our tertiary referral centre with acute abdominal pain and vomiting suspected for internal herniation. She had a history of a primary banded Roux-en-Y gastric bypass (B-RYGB). The MRI scan showed a clustered small bowel package with possible mesenteric swirl diagnosed as internal herniation. A diagnostic laparoscopy was converted to laparotomy showing an internal herniation of the alimentary limb through the silicone ring. The internal herniation was reduced by cutting the silicone ring. Postoperative recovery, remaining pregnancy and labour were uneventful. During pregnancy after B-RYGB, small bowel obstruction can in rare cases occur due to internal herniation through the silicone ring. Education regarding this complication should be provided before bariatric surgery. Treatment of women, 24 to 32 weeks pregnant, in a specialised centre for bariatric complications with a neonatal intensive care unit is advised to improve maternal and neonatal outcome.

scholarly journals Internal hernia following total gastrectomy with Roux-en-Y reconstruction

2011 ◽  
Vol 93 (6) ◽  
pp. e71-e73 ◽  
Author(s):  
JO Larkin ◽  
F Cooke ◽  
N Ravi ◽  
JV Reynolds
Keyword(s):  
Gastric Bypass ◽  
Small Bowel ◽  
Total Gastrectomy ◽  
Internal Hernia ◽  
Bypass Surgery ◽  
Gastric Bypass Surgery ◽  
Postoperative Recovery ◽  
Entire Small Bowel ◽  
History Of ◽  
Swirl Sign

Internal herniation is a well-described complication after a gastric bypass, particularly when performed laparoscopically, although it is rarely described following a total gastrectomy. A 55-year-old lady presented with a 24-hour history of vomiting and rigors 10 months after a radical total gastrectomy with Roux-en-Y reconstruction for a gastric adenocarcinoma. Computed tomography (CT) showed a complete small bowel obstruction and a mesenteric swirl sign, indicating a possible internal hernia. The entire small bowel was found at laparotomy to have migrated through the mesenteric defect adjacent to the site of the previous jejunojejunostomy and was dark purple and aperistaltic. The small bowel was reduced through the defect. At a second laparotomy, the small bowel looked healthy and the defect was repaired. Postoperative recovery was unremarkable. Of numerous signs described, the mesenteric swirl sign is considered the best indicator on CT of an internal hernia following Roux-en-Y reconstruction in gastric bypass surgery. A swirl sign on CT in a patient with abdominal pain should always raise the suspicion of an internal hernia.

The Natural History of Trisomy 21: Outcome Data from a Large Tertiary Referral Centre

2021 ◽  
pp. 1-7
Author(s):  
Clare O’Connor ◽  
Rebecca Moore ◽  
Peter McParland ◽  
Heather Hughes ◽  
Barbara Cathcart ◽  
...  
Keyword(s):  
Trisomy 21 ◽  
Pregnancy Loss ◽  
Loss Rate ◽  
Outcome Data ◽  
Second Trimester ◽  
Referral Centre ◽  
Tertiary Referral ◽  
Tertiary Referral Centre ◽  
History Of ◽  
Baseline Demographic

<b><i>Objective:</i></b> The aim of the study was to prospectively gather data on pregnancy outcomes of prenatally diagnosed trisomy 21 (T21) in a large tertiary referral centre. <b><i>Methods:</i></b> Data were gathered prospectively in a large tertiary referral centre over 5 years from 2013 to 2017 inclusively. Baseline demographic and pregnancy outcome data were recorded on an anonymized computerized database. <b><i>Results:</i></b> There were 1,836 congenital anomalies diagnosed in the study period including 8.9% (<i>n</i> = 165) cases of T21. 79% (<i>n</i> = 131) were age 35 or older at diagnosis. 79/113 (69.9%) women chose a termination of pregnancy (TOP) following a diagnosis of T21. Amongst pregnancies that continued, there were 4 second-trimester miscarriages (4/34, 11.7%), 9 stillbirths (9/34, 26.4%), and 1 neonatal death, giving an overall pregnancy and neonatal loss rate of 14/34 (41.1%). <b><i>Conclusion:</i></b> The risk of foetal loss in prenatally diagnosed T21 is high at 38% with an overall pregnancy loss rate of 41.1%. This information may be of benefit when counselling couples who are faced with a diagnosis of T21 particularly in the context of limited access to TOP.

scholarly journals A Bezoar Causing Bowel Obstruction After Roux-en-Y Gastric Bypass: A Case Report

2019 ◽  
Author(s):  
Alireza Tavassoli ◽  
Mehrdad Fakhlaei ◽  
Fatemeh Sadat Abtahi Mehrjardi ◽  
Mehrdad Gazanchian
Keyword(s):  
Bariatric Surgery ◽  
Gastric Bypass ◽  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Eating Habits ◽  
Gastric Surgery ◽  
Prior History ◽  
History Of ◽  
High Level

Abstract- We aimed to present a patient with phytobezoar causing small bowel obstruction after Roux-en-Y gastric bypass. Thirty-year-old woman with a history of prior Roux-en-Y gastric bypass due to morbid obesity three years ago presented with colicky abdominal pain, distention, nausea, vomiting, and obstipation. Initial abdominal X-ray showed various distended small bowel loops with air-fluid levels. The patient was taken to operation room for laparoscopic exploration, and a phytobezoar was found in distal jejunum. The bezoar was fragmented and flushed through cecum. The patient tolerated the surgery and her symptoms relieved without complication. Moreover, she received dietary consultation in order to prevent future recurrences. Small bowel obstruction in a patient with prior abdominal surgery is mainly caused due to adhesions, stenosis of anastomosis and hernias. An uncommon cause for obstruction is bezoar formation. The majority of patients with bezoars have a history of gastric surgery. Diagnostic imaging is not always helpful, and surgical exploration is sometimes required for diagnosis. Treatment is mainly surgical, but conservative medical treatment is also reported to be helpful. Apart from removal of bezoar, a dietary consultation is required to avoid eating habits leading to bezoar formation. Bariatric surgery is becoming more common; thus its complications are becoming more common as well. Majority of patients with bezoars have a prior history of gastric surgery. Therefore it is important to maintain a high level of suspicion for timely diagnosis of bezoars in patients with prior history of bariatric surgery, especially Roux-en-Y gastric bypass.

Small Bowel Ischemia after Roux-en-Y Gastric Bypass Complicated by Pregnancy: A Case Report

2005 ◽  
Vol 71 (3) ◽  
pp. 231-234 ◽  
Author(s):  
Anthony Charles ◽  
Shirley Domingo ◽  
Aaron Goldfadden ◽  
Jason Fader ◽  
Richard Lampmann ◽  
...  
Keyword(s):  
Morbid Obesity ◽  
Gastric Bypass ◽  
Case Report ◽  
Small Bowel ◽  
Bowel Ischemia ◽  
Unusual Complication ◽  
Childbearing Age ◽  
Diffuse Abdominal Pain ◽  
Gastric Bypass Procedure ◽  
History Of

Small bowel obstruction is an unusual complication of pregnancy. Its occurrence after Roux- en-Y gastric bypass (RYGB) for morbid obesity complicated by pregnancy is rare. Morbid obesity describes body weight at least 100 lb over the ideal weight, or a body mass index (BMI) ≥40. Surgery offers the only viable treatment option with long-term weight loss and maintenance. This case report involves a 23-year-old female at 25 weeks gestation with a 1-day history of diffuse abdominal pain and vomiting. She had a RYGB with a 15 cc micropouch 6 months prior to the commencement of this pregnancy. All radiologic investigations were normal. Esophagogastroscopy was performed revealing an ischemic Roux limb of the gastric bypass. At laparotomy, an internal hernia involving the afferent limb was identified at the site of the Roux anastomosis compromising portions of both the afferent and Roux limbs. Nonviable portions of both the afferent and Roux limbs were resected. Gastrointestinal continuity was achieved by fashioning a gastro-gastrostomy and a jejuno-jejunostomy, thus reversing the original gastric bypass procedure. The immediate postoperative period was complicated by fetal demise. With the increase in bariatric surgery, small bowel ischemia after Roux- en-Y gastric bypass will most likely become more prevalent, particularly in women of childbearing age.

Should Surveillance Endoscopy Be Routine After One Anastomosis Gastric Bypass to Detect Marginal Ulcers: Initial Outcomes in a Tertiary Referral Centre

2020 ◽  
Vol 30 (12) ◽  
pp. 4974-4980 ◽  
Author(s):  
Aditya Baksi ◽  
Devanish N. H. Kamtam ◽  
Sandeep Aggarwal ◽  
Vineet Ahuja ◽  
Lokesh Kashyap ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
One Anastomosis Gastric Bypass ◽  
Referral Centre ◽  
Tertiary Referral ◽  
Tertiary Referral Centre ◽  
Surveillance Endoscopy

scholarly journals Acute presentation of cocoon abdomen as septic peritonitis mimicking with strangulated internal herniation: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Sabah Uddin Saqib ◽  
Rimsha Farooq ◽  
Omair Saleem ◽  
Sarosh Moeen ◽  
Tabish Umer Chawla
Keyword(s):  
Case Report ◽  
Small Bowel ◽  
Emergency Room ◽  
Bowel Obstruction ◽  
Emergency Setting ◽  
Internal Herniation ◽  
Sclerosing Peritonitis ◽  
Acute Presentation ◽  
Septic Peritonitis ◽  
History Of

Abstract Background Abdominal cocoon syndrome is a rare cause of intestinal obstruction in which loops of small bowel get entrapped inside a fibro-collagenous membrane. Condition is also known in the literature as sclerosing peritonitis and in the majority of cases, it has no known cause. Although the majority of patients exhibit long-standing signs and symptoms of partial bowel obstruction in an out-patient clinic, its acute presentation in the emergency room with features of sepsis is extremely rare. This case report aims to describe the emergency presentation of cocoon abdomen with septic peritonitis. Case presentation A 35-year-old male with no known co-morbidity and no prior history of prior laparotomy presented in emergency room first time with a 1-day history of generalized abdomen pain, vomiting, and absolute constipation. He was in grade III shock and had metabolic acidosis. The clinical impression was of the perforated appendix, but initial contrast-enhanced computed tomography (CECT) was suggestive of strangulated internal herniation of small bowel. Emergency laparotomy after resuscitation revealed hypoperfused, but viable loops of small bowel entrapped in the sclerosing membrane. Extensive adhesiolysis and removal of the membrane were performed and the entire bowel was straightened. Postoperatively he remained well and discharged as planned. Histopathology report confirms features of sclerosing peritonitis. Discussion Cocoon abdomen is a very rare cause of acute small bowel obstruction presenting in an emergency with features of septic peritonitis. Condition is mostly chronic and generally mimics abdominal TB in endemic areas like India and Pakistan. A high index of suspicion is required in an emergency setting and exploratory laparotomy is diagnostic and therapeutic as well and the condition mimics internal herniation in acute cases. Conclusion Cocoon abdomen as a cause of septic peritonitis is extremely rare and might be an unexpected finding at laparotomy. Removal of membrane and estimation of the viability of entrapped bowel loops is the treatment of choice, which may require resection in the extreme case of gangrene.

scholarly journals Petersen-hernia, egy ritka sérvtípus megjelenése osztályunkon

2021 ◽  
Vol 74 (3) ◽  
pp. 71-74
Author(s):  
Keresztély Merkel ◽  
Tímea Vass ◽  
György Herczeg ◽  
Péter Ágh ◽  
Miklós Máté
Keyword(s):  
Gastric Bypass ◽  
Small Bowel ◽  
Intestinal Tract ◽  
Alimentary Tract ◽  
Alimentary Limb ◽  
Surgical Department ◽  
Surgical History ◽  
History Of ◽  
Small Intestinal ◽  
Colon Transversum

Összefoglaló. 61 éves nőbeteg anamnéziséből 3 évvel korábbi, morbid obezitás miatti bariátriai műtét (Roux Y gastric bypass, műtét előtti BMI 42, aktuális BMI 22), hysterectomia, hypertonia említendő. Négy napja tartó diffúz hasi fájdalom, hányás, hányinger, székletkimaradás miatt került SBO érintésével sebészeti osztályunkra. Felvételkor mérsékelt hasi distenzió, diffúz felhasi 3-5/10 fájdalom volt, defensus nélkül, NG szonda jelentős tartalmat nem hozott. Ileusra jellemző auscultációt, rectalis vizsgálattal üres ampullát találtunk. Álló natív hasi felvételen jobb oldalon L II–III. csigolya mellett kissé gázos, nem tágabb vékonybélkacs került leírásra, benne 2-3 cm-es nívóval. Hasi UH-vizsgálaton folyadékkal telt, tág, 30–35 mm átmérőjű vékonybeleket írtak le. CT-vizsgálat során a duodenum, jejunum és néhány proximalis ileumkacs kóros distensióját igazolták, nívókkal, innen aboralisan összeesett vékonybeleket. Tekintettel a kliniko-radiológiai képre, urgens műtét során Hasson-technikával laparoszkópos inspekciót végeztünk, azonban a masszív ileus okozta térhiány miatt kp medián laparotómiára konvertáltunk. Az exploráció során a Petersen-hernián át a jobb hasfélbe herniálódott alimentáris, biliopancreatikus és közös vékonybélszakaszt észleltünk a terminális ileum közepéig. A bél életképesnek bizonyult. A Petersen-hernián át a kizáródott szakaszt a bal hasfél felé visszahelyeztük, majd a Petersen-herniát nem felszívódó fonallal a colon transversum és az alimentáris kacs mezentériuma közt tovafutó varrattal zártuk. A beteg az ötödik postoperatív napon gyógyultan távozott. Summary. 61 years old female with previous surgical history of Roux-en-Y gastric bypass (3 years ago) and earlier hysterectomy admitted to our surgical department with clinical and radiological signs of small intestinal obstruction. Urgent intervention had been performed with following findings: Petersen herniation of alimentary tract including the – biliopancreatic tract and the small bowel extending to the midpart of the terminal ileum. Viability of herniated intestinal tract had been confirmed, and reposition of herniated parts through the Petersen hernia had been done. Closure with non-absorbable running suture of the gap between the transverse colon and the mesenteriun of the alimentary limb had been performed. Patient was fit for discharge on the fifth postoperative day.

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