Type IV Hiatal Hernia Containing the Gastric Pouch and Proximal Roux Limb: A Rare Cause of Bowel Obstruction Following Roux-en-Y Bypass Surgery

Abstract Background Small bowel obstruction is a known and potentially lethal complication after gastric bypass surgery, in both the early and the late postoperative course. Colon or large bowel obstruction, on the other hand, seems to be rare after gastric bypass surgery and thus is not routinely considered. Case presentation We present the case of a 21-year old morbidly obese caucasian patient who underwent laparoscopic Roux-en-Y gastric bypass surgery and developed an early severe transverse colon obstruction due to compression of the transverse colon by the antecolic alimentary limb. Emergency revisional surgery showed a short and tense alimentary limb mesentery and possibly tight closure of Petersen’s space contributing to the compression. Through opening of Petersen’s space and mobilization of alimentary limb mesentery, decompression was achieved, and the patient fully recovered. Conclusions This is a rare case of colon obstruction caused by direct compression of the transverse colon by the antecolic alimentary limb. We propose that a combination of short tense alimentary limb mesentery and perhaps tight closure of Petersen’s space was responsible for the obstruction in this case. Surgeons and treating physicians need to be aware of such rare causes of early postoperative bowel obstruction and take these into consideration when evaluating patients.

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Taxonomy and Imaging Spectrum of Small Bowel Obstruction After Roux-en-Y Gastric Bypass Surgery

American Journal of Roentgenology ◽

10.2214/ajr.09.2840 ◽

2010 ◽

Vol 194 (1) ◽

pp. 120-128 ◽

Cited By ~ 15

Author(s):

Abhijit Sunnapwar ◽

Kumaresan Sandrasegaran ◽

Christine O. Menias ◽

Mark Lockhart ◽

Kedar N. Chintapalli ◽

...

Keyword(s):

Gastric Bypass ◽

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Bypass Surgery ◽

Gastric Bypass Surgery

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Abdome Agudo Obstrutivo por hérnia hiatal tipo IV – Um relato de caso / Obstructive acute abdomen for type IV hiatal hernia – A case report

Brazilian Journal of Health Review ◽

10.34119/bjhrv3n4-311 ◽

2020 ◽

Vol 3 (4) ◽

pp. 10460-10469

Author(s):

Gabriela Ribeiro de Oliveira ◽

Felipe Sant'Maria Naques ◽

Vivian Zampieri de Souza ◽

Rodolpho Cesar Oliveira Mellem Kairala ◽

Maria Clara Nobrega Pereira ◽

...

Keyword(s):

Case Report ◽

Hiatal Hernia ◽

Acute Abdomen ◽

Type Iv

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PS01.072: IT IS NOT ALWAYS RISKY USING MESH IN THE TREATMENT OF HIATAL HERNIA

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.072 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 69-69

Author(s):

Maximiliano Loviscek ◽

Mauro Acosta ◽

Oscar Crespin ◽

Guido Orbe ◽

Cesar Villamil ◽

...

Keyword(s):

Hiatal Hernia ◽

Conflicts Of Interest ◽

Synthetic Mesh ◽

Gastric Erosion ◽

Type I ◽

Intrathoracic Stomach ◽

Type Iii ◽

Type Iv ◽

Low Incidence

Abstract Background Many studies have shown that the importance of using mesh for paraesophageal hernia repair (PEHR) is to prevent recurrence. Unfortunately, it is associated with high risk of complications such as esophageal or gastric erosion. The aim of this study is to report the results of 38 patients who underwent laparoscopic PEHR with the use of a BioSynthetic mesh (GoreÒ Bio AÒ tissue Reinforcement.USA). Methods Observational, retrospective, single-center cohort study. We analysed retrospectively 38 consecutive patients with diagnosis of symptomatic Hiatal Hernia (HH) treated laparoscopically with an absorbable BioSynthetic mesh, between 2011–2017. The classic radiologic classification was used to classify the HH before surgery. This classification consists in four types/stages (I-IV). I: Sliding HH, II: Paraesophageal HH, III: Mixed form and IV: Intrathoracic stomach—upside-down hernia. All patients with Type III—IV hiatal hernia who underwent laparoscopic PEHR using an absorbable BioSynthetic mesh were included. We evaluated the results after PEHR with a symptoms questionnaire using a score 0–4 (Likert scale) and with an esophagogram and an esophagogastroduodenoscopy (EGD) analyzing the surgical success. Success was considered with symptomatic score improvement and/or absence of any symptomatic HH at the esophagogram and/or EGD. Results 38 patients: 7 males and 31 women. Median age: 66 (range 40–71). 12/38 (31,6%) patients had a type III HH and 26/38 (68,4%) a type IV. All these patients had been treated with a laparoscopic PEHR, using an absorbable BioSynthetic mesh as a reinforcement of the crura and Nissen fundoplication. The median follow-up was 12 months. 16/38 (42%) had a follow-up > 24 months. Success was evident in 95% of the patients. We observed 2 recurrences, one with a symptomatic type I HH and the other with an early type III HH recurrence. Conclusion The use of an absorbable synthetic mesh as a reinforcement of the crura in the treatment of the PEH has encouraging good results in the mild term follow up, with an extremely low incidence of complications. Disclosure All authors have declared no conflicts of interest.

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