Intussusception after Roux-en-Y Gastric Bypass causing bowel obstruction. Report of one case

We report a 41 years old female who underwent a gastric bypass I 0 years ago. She presented an excess weight loss of 114%. She required a cholecystectomy and another surgical procedure due to an internal hernia. The patient complained of recurrent abdominal pain and an abdominal computed tomography showed an intestinal intussusception located at the jejuno-jejuno anastomosis. She was operated and the diagnosis was confirmed. An enlargement of the biliopancreatic loop and a bezoar were also found. A 15 em intestinal resection of the enlarged portion of the biliopancreatic loop and a new jejuno-jejuno anastomosis were performed. The patient recovered uneventfully and was discharged on the fourth postoperative day. The occurrence of intestinal intussuseeption as a cause of intestinal obstruction after gastric bypass is rare. It has been reported after open and laparoscopic surgery. There are several theories about the cause of intussusceotion, like changes in intestinal motility, a high excess weight loss, but a conclusive cause has not been identified. Generally the location of the intussusceptions is at the jejuno-jejuno anastomosis and it appears to be in a retrograde fashion in the majority l eases. The treatment is controversial, with several options; simple reduction, reduction and intestinal fixation, but apparently intestinal resection has better results.