Diagnostic laparoscopy is more accurate than Computerized Tomography for internal hernia after Roux-en-Y gastric bypass
ConclusionDiagnostic laparoscopy is more accurate than CT scan in evaluating patients with abdominal pain after RYGB.
The patient had a Roux en Y gastric bypass two years ago and had presented to an outside hospital for increasing abdominal pain. The patient was evaluated in the ER and was evaluated with a CT scan which was read as normal with no obstruction. General Surgery was consulted and felt patient would be appropriate for a medical floor bed. Patient was admitted to the medicine service with presumed diagnosis of marginal ulcer, placed on PPI and pain medications and GI medicine consult was obtained. Gastroenterology agreed with PPI's and schdeuled pt for outpatient endoscopy after discharge.
Conclusionclinicians should be aware of such condition in patients with history of bariatric surgery who present with long-standing, intermittent abdominal pain.
DISCUSSION: Intussusception after a RYGB is rare and the diagnosis is generally based on CT scan exam. Surgical exploration should be performed as soon as possible to prevent bowel ischemia and the need for resection. PMID: 30340865 [PubMed - as supplied by publisher]
ConclusionAlthough rare, intussusception after RYGBP must be considered as a possible cause of intestinal obstruction. In case of a small bowel intussusception, a surgical resection is recommended. A laparoscopic approach to treat bowel intussusception after RYGBP is safe and feasible.
ConclusionCauses of abdominal pain and GERD after RYGB are difficult to identify. Gastro-gastric fistula is one of them and should be evoked when biliary reflux and abdominal pain appear.
Conclusions: IH after LRYGB is difficult to detect. Our study found CT to have a low sensitivity but a high specificity in detecting IH. Therefore, laparoscopic exploration continues to be the best diagnostic and therapeutic intervention for this complication. PMID: 29279662 [PubMed - in process]
AbstractThe present video shows the laparoscopic management of an acute small bowel obstruction (ASBO) after a Roux-en-Y Gastric Bypass (RYGBP), due to the development of an intraluminal hemobezoar involving the jejuno-jejunostomy (j-j). On the first postoperative day (POD), the patient presented persistent abdominal pain, sense of fullness, nausea, and vomiting with traces of blood. The abdominal tube drained a small amount of serous fluid, while blood tests revealed a mild leukocytosis and a slight decrease of the hemoglobin. A CT scan showed the dilation of the excluded stomach, duodenum, and both the alimentary and bil...
ConclusionRecurrent abdominal pain is not uncommon after LRYGB. Systematic closure of mesenteric defects, the use of diagnostic laparoscopy, and high index of suspicion are all necessary to avoid delay in diagnosis.
novic G Abstract The frequency of bariatric operations has increased in Germany. Primary operations are usually performed at specialised centres. However, late complications may develop months or even years after the operation, and every general and visceral surgeon may be confronted with them, regardless of the size and specialisation of their clinics. The laparoscopic Roux-Y gastric bypass is the most frequently performed bariatric operation worldwide. During this procedure, the alimentary loop is lifted up in front of the colon to form a pouch, which creates a mesenteric space, also called the Petersen space, d...
Conclusion In case of clinical suspicion of IH, even in case of normal laboratory and radiological findings, a surgical exploration is indicated.