Type of publication:
Conference abstract
Author(s):
*Gungadin P.; *Bhandari M.; *Riera M.;
Citation:
Obesity Surgery. Conference: BOMSS 2024 Congress. Harrogate . 34(Supplement 1) (pp S26), 2024. Date of Publication: 01 Jun 2024.
Abstract:
Introduction: Small bowel obstruction following jejunojejunal anastomosis (JJ) during a gastric bypass is a recognised complication. Common causes include strictures, intussusception, internal herniae and bowel kinking, thus preventing passage of bowel contents into the common limb (CL). Bidirectional jejunal stapled anastomosis, or triple line anastomosis is meant to decrease the risk of obstruction. However, this risk may not completely be avoided. Case presentation: A patient with history of gastroesophageal reflux, after a sleeve gastrectomy, underwent a conversion to laparoscopic Roux-en-Y gastric bypass. The JJ anastomosis was successfully tested intraoperatively for leak and patency with methylene blue. The patient still developed post-operative bilious vomiting after 24 hours. Abdominal CT confirmed obstruction at the JJ anastomosis. Subsequent laparoscopy demonstrated collapsed CL and dilated both alimentary (AL) and biliopancreatic (BP) limbs. There was no stricture or narrowing. Upon straightening the limbs, bowel contents successfully emptied into the common limb. However, the common limb would appear kinked again when the anastomosis was released, thus causing obstruction. A further stapled anastomosis was performed between CL and BP which straightened the kinked CL. This solved the obstruction. The patient was discharged home three days later. Discussion(s): Small bowel obstruction secondary to kinking despite a triple stapler approach is uncommon. Unfortunately, anastomotic leak and patency test may not completely preclude this complication. Awareness and careful intraoperative inspection of the anastomosis may help to detect probable obstruction.
DOI: 10.1007/s11695-024-07287-1
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