Hospital: Hospital Universitario Vall d’Hebron.
Ciudad:
Nº:
Aut@r o Autores: E. Moraru, E. Rodriguez Zafra, E. Castellá Fierro, X. Guri Azogue, J. Salvador Civil, M. Rios Vives.,
Presentación:
64-years old women underwent a Roux-en-Y gastric bypass (bariatric surgery). There were no complications during the surgery. 24 hours after surgery the patient presented several coffee-ground emesis, which were treated medically. At 48 hours the patient presented with significant epigastric pain and peritonitis signs. An abdominal CT scan was performed to rule out anastomotic leak. The CT scan revealed a significant dilation of the biliopancreatic limb up to gastric remnant and an hyperdense content in the bowel lumen, compatible with a clot. There were no signs of anastomotic leak or failure. The patient underwent to laparoscopic surgery that evidenced dilation of the biliopancreatic limb and the antral region of the gastric remnant, and performed enterotomy with aspiration of 700 ml of hematic and biliary content. Foley catheter was left as a decompressive gastrostomy.
Discusión:
The small bowel obstruction is a severe complication after laparoscopic Rouxen-Y gastric bypass, that may be secondary to internal hernias, anastomotic stenosis or adhesions, and more rarely, intussusceptions or hemobezoar. The blood clot formation after bleeding in staple lines anastomosis induces a jejuno-jejunal obstruction with hematic liquid accumulation. In order to recognize this complication, the following key points must be known: – Knowledge of the normal postoperative Roux-en-Y gastric bypass appearance – Clinical presentation is abdominal pain and vomiting with traces of blood in the early post-op (2-5º day) – CT scan shows a transition point from dilated small-bowel segments to non dilated small bowell – Hyperdense content (50-80 HU) in the bowel lumen that suggests an intraluminal clot.
Conclusión:
The small bowel obstruction is a severe complication after laparoscopic Rouxen-Y gastric bypass, that may be secondary to internal hernias, anastomotic stenosis or adhesions, and more rarely, intussusceptions or hemobezoar. The blood clot formation after bleeding in staple lines anastomosis induces a jejuno-jejunal obstruction with hematic liquid accumulation. In order to recognize this complication, the following key points must be known: – Knowledge of the normal postoperative Roux-en-Y gastric bypass appearance – Clinical presentation is abdominal pain and vomiting with traces of blood in the early post-op (2-5º day) – CT scan shows a transition point from dilated small-bowel segments to non dilated small bowell – Hyperdense content (50-80 HU) in the bowel lumen that suggests an intraluminal clot.
Bibliografía:
– Soricelli E, Facchiano E, Quartararo G, Beltrame B, Leuratti L, Lucchese M. Large Hemobezoar Causing Acute Small Bowel Obstruction After Roux-en-Y Gastric Bypass: Laparoscopic Management. Obes Surg. 2017,27(7):1906-1907 – Koppman JS, Li C, Gandsas A. S