Background

Roux-en-Y Gastric Bypass (RYGB) is among the most commonly performed bariatric operations, and internal hernias, although rare, are the most feared complications. The three most common herniation sites include the transverse mesocolon, the jejuna-mesenteric defect at the level of the jejuno-jejunostomy site, and Petersen's space.Usually, the small bowel is the mostly likely herniation content, however colonic herniation might also occur. Although ante-colic configurations and complete closure of Petersen's space are associated with a lower rate of internal hernias, this could in fact cause cause an uncommon extrinsic colonic compression.Usually, the time of presentation of colonic obstruction after RYGB varies from days to weeks to years. The risk factors associated with extrinsic colonic obstruction include 1) Ante-colic Ante-gastric Roux Limb 2) Short Roux Limb mesenteric and 3) Tight closure of Petersen's space. Surgeons must be aware of this unique type of colonic obstruction after RYGB because as it might lead to massive colonic distension and subsequent perforation. In this video presentation, we report three unusual transverse colon obstruction cases caused by mesenteric compression and tight closure of Petersen's space after RYGB.