CLINICAL IMAGE
Snapshots in surgery: small bowel intussusception following ileojejunal bypass Joseph Ward, Basel Jaber, Charlotte Leaman, Jonathan Barry & Umesh Khot Department of Surgery, Morriston Hospial, Abertawe Bro Morgannwg University Health Board, Heol Maes Eglwys, Morriston, Swansea, Wales, SA6 6NL, United Kingdom
Correspondence Joseph Ward, Department of Surgery, Morriston Hospial, Abertawe Bro Morgannwg University Health Board, Heol Maes Eglwys, Morriston, Swansea, Wales SA6 6NL, United Kingdom. Tel: 01792 703573; Fax: 01792 545799; E-mail: [email protected]
Key Clinical Message
Funding Information No funding information provided.
Abdominal pain, bariatric surgery, ileojejunal bypass, intussusception.
Jejunal intussusception is a known complication of ileojejunal bypass surgery for obesity that may present as an acute abdomen. It can be avoided if the jejunum is anchored to the transverse mesocolon intra-operatively. Keywords
Received: 3 January 2014; Revised: 26 May 2014; Accepted: 6 July 2014 Clinical Case Reports 2014; 2(6): 338–339 doi: 10.1002/ccr3.132
Questions
Answer
What do the Figures 1 and 2 demonstrate? How might it be avoided?
A 41-year-old woman presented with a 1 year history of generalized spasmodic abdominal pain and nausea with-
(A)
(B)
Figure 1. Pre-operative CT imaging (A) Coronal view. (B) Axial view.
338
ª 2014 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
J. Ward et al.
Small bowel intussusception following ileojejunal bypass
(Fig. 1) demonstrated small bowel intussusception and an exploratory laparotomy (Fig. 2) confirmed intussusception of the bypassed jejunal segment. This clinical case highlights that those bariatric patients with persistent vague or nonspecific abdominal pain presenting to hospital should be investigated. Previous bariatric surgery may lead to masking of the signs and symptoms of gastroenteric pathology. These patients may present unusually and be missed if symptoms are ignored [1, 2]. Intussusception of the jejunal segment is a reported complication of ileojejunal bypass [1, 2] and may be avoided if the jejunum is anchored to the transverse mesocolon intra-operatively [2].
Conflict of Interest None declared. References Figure 2. Intra-operative findings.
out obstructive symptoms. Three years previously, the patient had undergone a laparoscopic vertical sleeve gastrectomy and ileojejunal bypass (proximal jejunum anastomosed to terminal ileum with formation of a distal jejunal roux-en Y loop) for morbid obesity. CT imaging
ª 2014 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
1. Lavery, I. C., and V. W. Fazio. 1978. Intussusception following jejunoileal bypass for morbid obesity: report of a case. Dis. Colon Rectum 21:128–129. 2. Starkloff, G. B., R. A. Shively, and J. G. Gregory. 1977. Jejunal intussusceptions following small bowel bypass for morbid obesity. Ann. Surg. 185:386–390.
339
Snapshots in surgery: small bowel intussusception following ileojejunal bypass Joseph Ward, Basel Jaber, Charlotte Leaman, Jonathan Barry & Umesh Khot Department of Surgery, Morriston Hospial, Abertawe Bro Morgannwg University Health Board, Heol Maes Eglwys, Morriston, Swansea, Wales, SA6 6NL, United Kingdom
Correspondence Joseph Ward, Department of Surgery, Morriston Hospial, Abertawe Bro Morgannwg University Health Board, Heol Maes Eglwys, Morriston, Swansea, Wales SA6 6NL, United Kingdom. Tel: 01792 703573; Fax: 01792 545799; E-mail: [email protected]
Key Clinical Message
Funding Information No funding information provided.
Abdominal pain, bariatric surgery, ileojejunal bypass, intussusception.
Jejunal intussusception is a known complication of ileojejunal bypass surgery for obesity that may present as an acute abdomen. It can be avoided if the jejunum is anchored to the transverse mesocolon intra-operatively. Keywords
Received: 3 January 2014; Revised: 26 May 2014; Accepted: 6 July 2014 Clinical Case Reports 2014; 2(6): 338–339 doi: 10.1002/ccr3.132
Questions
Answer
What do the Figures 1 and 2 demonstrate? How might it be avoided?
A 41-year-old woman presented with a 1 year history of generalized spasmodic abdominal pain and nausea with-
(A)
(B)
Figure 1. Pre-operative CT imaging (A) Coronal view. (B) Axial view.
338
ª 2014 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
J. Ward et al.
Small bowel intussusception following ileojejunal bypass
(Fig. 1) demonstrated small bowel intussusception and an exploratory laparotomy (Fig. 2) confirmed intussusception of the bypassed jejunal segment. This clinical case highlights that those bariatric patients with persistent vague or nonspecific abdominal pain presenting to hospital should be investigated. Previous bariatric surgery may lead to masking of the signs and symptoms of gastroenteric pathology. These patients may present unusually and be missed if symptoms are ignored [1, 2]. Intussusception of the jejunal segment is a reported complication of ileojejunal bypass [1, 2] and may be avoided if the jejunum is anchored to the transverse mesocolon intra-operatively [2].
Conflict of Interest None declared. References Figure 2. Intra-operative findings.
out obstructive symptoms. Three years previously, the patient had undergone a laparoscopic vertical sleeve gastrectomy and ileojejunal bypass (proximal jejunum anastomosed to terminal ileum with formation of a distal jejunal roux-en Y loop) for morbid obesity. CT imaging
ª 2014 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
1. Lavery, I. C., and V. W. Fazio. 1978. Intussusception following jejunoileal bypass for morbid obesity: report of a case. Dis. Colon Rectum 21:128–129. 2. Starkloff, G. B., R. A. Shively, and J. G. Gregory. 1977. Jejunal intussusceptions following small bowel bypass for morbid obesity. Ann. Surg. 185:386–390.
339
