Fetal Growth and Adipose Fat Tissue Trajectories in Twin Pregnancies after Gastric Bypass Surgery

Introduction: Previous studies demonstrated a continues decline in fetal growth throughout singleton pregnancy after bariatric surgery. However, intrauterine growth in twin pregnancy is subjected to further underlying processes. This study was to investigate the longitudinal assessment of fetal biometry and abdominal fat thickness of twin pregnancies conceived after gastric bypass surgery and compare them to BMI-matched and obese controls. Materials and methods: We retrospectively assessed ultrasound data of 30 women with dichorionic-diamniotic twin pregnancy (11 women after gastric bypass surgery, 9 obese mothers with pregestational BMI ≥ 30 kg/m² and 10 BMI and age matched controls). We assessed fetal growth parameters including fetal subcutaneous adipose tissue thickness (FSCTT) as well as newborn biometry after delivery. Patient characteristics were obtained from the medical records. Results: The rise in FSCTT curves was markedly slower in twin offspring of women with history of gastric bypass as compared to offspring of obese mothers and offspring of BMI matched controls. Hence, FSCTT was significantly decreased in gastric bypass offspring as compared to both control groups at 34 weeks of gestation. Also, growth curves of abdominal circumference were decreased in offspring of gastric bypass patients as compared to obese mothers. Infants of mothers with history of gastric bypass showed significantly lower birth weight percentiles compared to newborns of obese mothers (27.2 vs 48.8 pct, p=0.025). There was no significant difference in inter twin birth weight difference between offspring of gastric bypass (median: 9.9%, IQR: 6.5 to 20.0) vs. obese (median: 14.6%, IQR: 8.2 to 21.6) and BMI matched controls (median: 9.0%, IQR: 6.3 to 12.6, p=0.714). Conclusions: In summary, intrauterine growth delay in twin pregnancies after GB is assumed to be a multifactorial event with altered metabolism as the most important factor. However, special attention must be paid to the particularity of twin pregnancies as they seem to be subject to other additional mechanism.

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Fetal Growth in Twin Pregnancies

Acta geneticae medicae et gemellologiae twin research ◽

10.1017/s0001566000004232 ◽

1988 ◽

Vol 37 (1) ◽

pp. 35-39 ◽

Cited By ~ 4

Author(s):

J.P. Neilson

Keyword(s):

Birth Weight ◽

Fetal Growth ◽

Gestational Age ◽

Twin Pregnancy ◽

Abdominal Circumference ◽

Trunk Flexion ◽

Twin Pregnancies

AbstractIn 65 consecutive twin pregnancies, 722 measurement of fetal abdominal circumference have been obtained with ultrasound. Zygosity was established after delivery in 85% of the pregnancies. There was no difference in mean abdominal circumference measurements between monozygotic and dizygotic pregnancies. In both groups, the pattern of growth was linear throughout pregnancy in contrast to that predicted by birth-weight for gestational age charts. It is suggested that increasing trunk flexion, in later twin pregnancy, may distort accurate abdominal circumference measurement.

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

Annals of The Royal College of Surgeons of England ◽

10.1308/147870811x590333 ◽

2011 ◽

Vol 93 (6) ◽

pp. e71-e73 ◽

Cited By ~ 4

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.

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Pre-pregnancy gastric bypass surgery is associated with severe fetal growth delay during the second half of pregnancy

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/j.ejogrb.2018.08.396 ◽

2019 ◽

Vol 234 ◽

pp. e108

Author(s):

Michael Feichtinger ◽

Veronica Falcone ◽

Theresa Schönleitner ◽

Tina Stopp ◽

Peter Husslein ◽

...

Keyword(s):

Gastric Bypass ◽

Fetal Growth ◽

Bypass Surgery ◽

Gastric Bypass Surgery ◽

Growth Delay

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Short Bowel Syndrome from Strangulated Internal Hernia After Childbirth in a Patient With a History of Gastric Bypass Surgery: Case Report

JOURNAL OF ACUTE CARE SURGERY ◽

10.17479/jacs.2020.10.3.118 ◽

2020 ◽

Vol 10 (3) ◽

pp. 118-122

Author(s):

Jisu Lee ◽

Tae Sun Ha ◽

Jeonghwi Choi ◽

Yeonhwa Kwon ◽

Zisun Kim

Keyword(s):

Gastric Bypass ◽

Case Report ◽

Short Bowel Syndrome ◽

Internal Hernia ◽

Bypass Surgery ◽

Gastric Bypass Surgery ◽

Short Bowel ◽

History Of

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Fetal Growth in Pregnancies Conceived after Gastric Bypass Surgery in Relation to Surgery-to-Conception Interval: A Danish National Cohort Study

PLoS ONE ◽

10.1371/journal.pone.0090317 ◽

2014 ◽

Vol 9 (3) ◽

pp. e90317 ◽

Cited By ~ 21

Author(s):

Lone Nikoline Nørgaard ◽

Anne Cathrine Roslev Gjerris ◽

Ida Kirkegaard ◽

Janne Foss Berlac ◽

Ann Tabor ◽

...

Keyword(s):

Gastric Bypass ◽

Cohort Study ◽

Fetal Growth ◽

Bypass Surgery ◽

Gastric Bypass Surgery ◽

National Cohort

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Abdominal compartment syndrome following abdominoplasty: A case report and review

Indian Journal of Plastic Surgery ◽

10.4103/0970-0358.138978 ◽

2014 ◽

Vol 47 (02) ◽

pp. 263-266 ◽

Cited By ~ 3

Author(s):

Arash Izadpanah ◽

Ali Izadpanah ◽

Mihiran Karunanayake ◽

Christian Petropolis ◽

Dan L. Deckelbaum ◽

...

Keyword(s):

Gastric Bypass ◽

Case Report ◽

Compartment Syndrome ◽

Abdominal Compartment Syndrome ◽

Bypass Surgery ◽

Gastric Bypass Surgery ◽

Prior History ◽

Ischemic Bowel ◽

History Of ◽

Abdominal Compartment

ABSTRACTAbdominoplasty is among the most commonly performed aesthetic procedures in plastic surgery. Despite high complication rate, abdominal contouring procedures are expected to rise in popularity with the advent of bariatric surgery. Patients with a history of gastric bypass surgery have an elevated incidence of small bowel obstruction from internal herniation, which is associated with non-specific upper abdominal pain, nausea, and a decrease in appetite. Internal hernias, when subjected to elevated intra-abdominal pressures, have a high-risk of developing ischemic bowel. We present a case report of patient with previous laparoscopic Roux-en-y gastric bypass who developed acute ischemic bowel leading to abdominal compartment syndrome following abdominoplasty. To the best of our knowledge, this is the first reported case in the literature. We herein emphasise on the subtle symptoms and signs that warrant further investigations in prospective patients for an abdominal contouring procedure with a prior history of gastric bypass surgery.

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Retrograde Jejunogastric Intussusception (RJGI): A Life- Threatening Complication after Gastric Bypass Surgery

Journal of Bangladesh College of Physicians and Surgeons ◽

10.3329/jbcps.v33i3.28061 ◽

2016 ◽

Vol 33 (3) ◽

pp. 161-165

Author(s):

Imtiaz Faruk ◽

Sheikh Firoj Kabir ◽

Syed Mahbubul Alam ◽

Kh ABM Abdullah Al Hasan

Keyword(s):

Gastric Bypass ◽

Bypass Surgery ◽

Gastric Bypass Surgery ◽

Rare Complication ◽

Barium Meal ◽

Type Ii ◽

Jejunogastric Intussusception ◽

Life Threatening ◽

History Of ◽

Life Threatening Complication

Retrograde jejunogastric intussusception (RJGI) after gastric bypass surgery is a rare but potentially life threatening complication. This complication may develop after simple gastrojejunostomy, after lower partial resection of stomach with gastrojejunostomy (Billroth-II gastric surgery) or after Roux-en-Y gastric bypass. Among the three anatomic type of jejunogastric intussusception (JGI), type-II is the commonest variety. The acute form is a surgical emergency. Mortality rate is very high. Little is known about the mechanism but many literatures indicate abnormal motility may be a cause. A 50 year old male presented to us with a three month history of repeated vomiting and one day of upper mid-abdominal pain. He had a history of gastric bypass for pyloric stenosis 12 years back. Diagnosis was confirmed by upper GI endoscopy. At laparotomy type II retrograde jejunogastric intussusception was identified. En-block resection of affected segment of jejunum and lower part of the stomach was done followed by Roux-en-Y reconstruction. RJGI is a rare complication of gastric bypass surgery. Early diagnosis is imperative. High index of suspicion is therefore important. Barium meal X-ray, ultra sonogram, enhanced CT scan occasionally be diagnostic, but endoscopy is certainly diagnostic in experienced hand. Laparotomy is mandatory. Surgical options include simple reduction, en-block resection and/or plication.J Bangladesh Coll Phys Surg 2015; 33(3): 161-165

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Copper Deficiency: A Forgotten Disorder?

Blood ◽

10.1182/blood.v118.21.5275.5275 ◽

2011 ◽

Vol 118 (21) ◽

pp. 5275-5275

Author(s):

Alireza Abdolmohammadi ◽

Vivek R. Sharma

Keyword(s):

Primary Care ◽

Gastric Bypass ◽

Folic Acid ◽

Peripheral Neuropathy ◽

Bypass Surgery ◽

Copper Deficiency ◽

Gastric Bypass Surgery ◽

Veterans Affairs ◽

History Of ◽

B12 Deficiency

Abstract 5275 Background: Copper is an essential trace element that is required for the function of a number of enzymes necessary for normal metabolic activities including ferroxidase I (ceruloplasmin) which functions to release iron from cells with mobilizable iron stores. Copper deficiency is well reported in the literature but is considered relatively rare. It appears primarily to result from poor absorption, even though the precise mechanism(s) may not be apparent in all cases. Importantly, copper deficiency is a masquerader. It frequently results in manifestations that could easily be mistaken for another condition leading potentially to misdiagnosis and inappropriate therapy. Unlike vitamin B12 and folate deficiencies however, many guidelines and textbooks make no mention of copper deficiency as a potential secondary cause for a myelodysplasia (MDS)-like presentation or neuropathy even though multiple reports have described these associations. Methods and Results: In order to formally explore physician awareness about copper deficiency at our own institution we reviewed the medical records of 46 patients that were referred to the department of Hematology and/or Neurology at the Louisville Veterans Affairs Medical Center by their primary care physicians during the year 2010. 23 (49%) and 24 (51%) patients were referred for cytopenia (s) / macrocytosis and/or peripheral neuropathy respectively. however; no clearly identifiable etiology was found. Among patients with cytopenia (s) / macrocytosis, 34.8% (n=8) had concomitant peripheral neuropathy, 91.3% (n=21) presented with anemia as a part of their cytopenia (s); of those, 43% (n=9) were deficient in Iron without any clear etiology and 8.7% (n=2) were diagnosed with myelodysplatic syndrome. 100% (23) of patients with cytopenia (s)/macrocytosis were evaluated for Folic Acid and B12 deficiency either by their Primary care physician or hematologist. Only two patients (8.7%) were diagnosed with B12 deficiency, of those, one (4.3%) was referred because of isolated macrocytosis with a normal serum copper level checked by the hematologist. 100% (n=24) of patients referred to the neurology clinic with peripheral neuropathy were evaluated for Folic Acid and B12 deficiency, all with normal results. However, none were evaluated for copper deficiency including one patient with a history of gastric bypass surgery. Among these patients, 47.8% (n=11) were identified with isolated peripheral neuropathy, 8.3% with concomitant anemia, 8.3% with thrombocytopenia, 33.3% (n=8) with diabetes mellitus or impaired glucose tolerance test, 12.5% (n=3) with a history of alcohol abuse, 4.2% (n=1) with a positive HIV test and 4.2% (n=1) with a history of gastric bypass surgery with concomitant thrombocytopenia. Conclusion: Our study albeit small and from a single institution points to a significant lack of awareness among physicians about copper deficiency as a possible diagnostic consideration in patients with cytopenias and/or neuropathy even though it has been clearly reported in the literature to be associated with a clinical presentation very similar to B12 deficiency. We believe that this is representative of the prevailing practice pattern in the medical community as a whole. It is understandable therefore that we do not really know the true incidence of a disorder that is rarely tested even in patients presenting with known clinical features associated with it. Finally, one of the most compelling reasons to recognize copper deficiency is that like B12 deficiency, this is a potentially devastating condition that is treatable with simple replacement therapy. Disclaimer: The contents of this abstract do not represent the views of the Department of Veterans Affairs or the US government. Disclosures: No relevant conflicts of interest to declare.

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