Intussusception after Roux-en-Y gastric bypass (RYGB) reported incidence of, can cause abdominal pain and obstructive symptoms. The cause is generally unknown but most often occurs with a retrograde peristalsis of the common channel into the jejujunojejunostomy without a distinct lead point. Risk factors include female patients and significant excess weight loss (EWL) years after gastric bypass.
We present a 42 year old woman 3 years after her gastric bypass with EWL of 93% presenting with abdominal pain intermittently over the last 2 years. History was significant for narcotic addiction and CT scan questions a mass, suture bezoar or non-obstructing intussusception at the jejujunojejunostomy. Management and all operations of this case was performed by outside surgeon.Video shows exploration of jejunojejunostomy where no masses or suture bezoar found. Resection of the jejunojejunostomy was performed with aberrant recreation with Roux limb anastomosed to biliopancreatic (BP) limb and the proximal stump of common channel and roux limb anastomosed 3 cm distance proximal from first anastomosis. Therefore, a Roux-en- O configuration was created. She returned to the operating room multiple times for gastrostomy tubes and exploration for obstructive symptoms, and eventually advised to recreate the jejunjojejunostomy in a standard fashion.
Intussusception after RYGB is an uncommon occurrence however aberrant reconstruction of the jejunojejunostomy can lead to major complications. Outside opinion is warranted when patients have recurrent obstructive symptoms after repair.