Retrograde intussusception causing small bowel obstruction in a 35 year old Female patient following a Roux en Y Bypass. Case report

Elham El-Darazi; Elias El-Khoury; Etienne El-Helou; Bilal El-Chamaa; Najib El-Atrash; Jad J Terro

doi:10.1016/j.ijscr.2021.01.095

Retrograde intussusception causing small bowel obstruction in a 35 year old Female patient following a Roux en Y Bypass. Case report

Int J Surg Case Rep. 2021 Mar:80:105601. doi: 10.1016/j.ijscr.2021.01.095. Epub 2021 Feb 1.

Authors

Elham El-Darazi¹, Elias El-Khoury², Etienne El-Helou³, Bilal El-Chamaa⁴, Najib El-Atrash⁵, Jad J Terro⁶

Affiliations

¹ Department of Nutrition, Faculty of Arts and Sciences, USEK, Lebanon. Electronic address: ilhamdarazi@hotmail.com.
² Department of Surgery, Central Military Hospital, Beirut, Lebanon. Electronic address: efkhoury@gmail.com.
³ Department of General Surgery, Faculty of Medical Sciences at Lebanese University, Beirut, Lebanon. Electronic address: Etienne-elhelou@hotmail.com.
⁴ Department of General Surgery, Hotel-Dieu de France University Hospital, Saint-Joseph University, Beirut, Lebanon. Electronic address: bilal.elchamaa@hotmail.com.
⁵ Department of General Surgery, Faculty of Medical Sciences at Lebanese University, Beirut, Lebanon. Electronic address: Drnajibalattrache@hotmail.com.
⁶ Department of Surgery, Central Military Hospital, Beirut, Lebanon; Department of General Surgery, Faculty of Medical Sciences at Lebanese University, Beirut, Lebanon. Electronic address: j.terro@hotmail.com.

Abstract

Introduction: Intestinal intussusception is an uncommon entity when preceded by Roux en Y gastric bypass. Retrograde intussusception is an enigmatic phenomenon characterized by reversely intussuscepted intestinal loop that may involve any piece of the Roux en Y limbs. Computed Tomography is gold standard for diagnosis. Surgical management is highly debatable.

Case presentation: A 35 years old female known for morbid obesity, post roux en Y gastric bypass since 5 years with 100 % excess weight loss presenting for on-off episodes of small bowel obstruction symptoms. She was diagnosed laparoscopically for retrograde intussusception that was reduced easily with closure of Peterson's pouch due to high suspicion of an internal hernia. She did well postoperatively and followed up adequately with no recurrence of her symptoms.

Conclusion: Retrograde intussusception remains an interesting uncommon phenomenon in the horizon of the roux en Y gastric bypass surgeries. Several surgical options were discussed in the last 12 years and they are still debatable.

Keywords: Case report; Diagnostic challenge; Laparoscopic reduction; Retrograde intussusception; Roux en Y Gastric Bypass.

Publication types

Case Reports