Small bowel intussusception after Roux-en-Y gastric bypass: A case report

Abstract

Introduction: Small bowel intussusception after Rouxen-Y gastric bypass is a rare condition, with a reported incidence of 0.07–0.6%, and a multifactorial etiology. The severity of the condition ranges from small bowel edema to ischemia and perforation with peritonitis, and the clinical presentation and blood tests are non-specific. The computed tomography (CT) scan is the best diagnostic tool in an emergency department context. Case Report: The authors present the case of a 41-year-old male patient, with history of Roux-en-Y gastric bypass two years before, who presented in the emergency department with acute onset abdominal pain and nausea. Abdominal exploration showed a tender mass in the left upper quadrant. Blood tests showed an increase in alanine transaminase (ALT) and aspartate transaminase (AST) and abdominal CT scan was compatible with a small bowel intussusception, without other findings. A diagnostic laparoscopy confirmed the diagnosis, and the intussusception was resolved without need of bowel resection. The patient showed no complications in the immediate post-operative period, with clinical and analytical improvement, and was discharged on the sixth post-operative day, without relevant complaints in the follow-up appointments. Conclusion: Due to the non-specific clinical presentation of small bowel intussusception, it is required a high level of suspicion in patients who underwent gastric bypass and present with abdominal pain. In terms of surgical approach, resolution of the intussusception may be enough in many cases, when there is no vascular compromise of the bowel, while the evidence of ischemia requires bowel resection.