Background

Revision of Roux-en-Y gastrojejunostomy resulting in remnant stomach volvulus This video demonstrates a gastric remnant volvulus after a Roux-en-Y gastric bypass revision. A 67-year-old woman with a history of morbid obesity (BMI 39) underwent a laparoscopic antecolic /antegastric Roux-en-Y gastric bypass 15 years prior to her presentation. She has maintained >100% excess weight loss at 15 years. Her long-term course has been complicated by both cigarette smoking and alcohol use disorder. She presented with a 2.5cm anterior perforation of her gastrojejunostomy (GJ) along with a posterior gastrogastric fistula. At the time of surgery, the gastrojejunostomy was resected en bloc along with a non-viable fundus and a new GJ anastomosis was performed. Her postoperative course was complicated by delirium tremens. She represented to the same institution 8 months later with vague band-like central abdominal pain with normal vitals. A CT scan demonstrated an intraabdominal remnant stomach volvulus with the 'upside-down' stomach in the lower abdomen obstructed at the level of the pylorus. A laparoscopic reduction and gastropexy was performed and the patient made an uneventful recovery, only to be complicated by a subsequent perforated marginal ulcer 7 months postop due to persistent cigarette smoking.There are few cases of intraabdominal remnant stomach volvulus reported in the literature. It is possible that the mobilization and partial resection of the gastric remnant at the time of the GJ revision contributed to the subsequent volvulus.