Background: Intestinal obstruction is a common late complication of Roux-en-Y gastric bypass surgery, most commonly due to internal herniation or anastomotic strictures. Bezoars are a rare cause of obstruction in this setting, with very few cases reported in literature. Case Report:The authors present the case of a 39-year-old female patient who underwent a laparoscopic Roux-en-Y gastric bypass for the treatment of severe obesity 9 years before her admission. Initially she weighed 140 kg, her body mass index was 50.8 kg/m 2 , and she didn't have any known comorbid conditions. She was admitted to the emergency department at the hospital with abdominal pain, distention, nausea, and vomiting over 20 episodes that started 16 hours before her admission. After workup, a decision was made to perform a laparoscopic exploration. An 8-cm phytobezoar obstructing the common channel of the bypass was found; it was composed mostly of orange fibers and slices. It was extracted via enterotomy. Results:In the postoperative period the obstructive syndrome was resolved, the patient was started on clear liquids in postoperative day 2 and sent home on postoperative day 5. The instructions were not to ingest large amounts of fiber and chewing on her meals. Her recovery was uneventful. Conclusions:To the best of the authors' knowledge there are about 15 reported cases of bezoar formation in patients who underwent Roux-en-Y gastric bypass surgery. As this procedure is more frequently performed worldwide, an increase on these types of cases is expected.
RESUMENIntroducción: el bazo accesorio intrapancreático (BAIP) es una condición benigna difícil de diferenciar de los tumores neuroendocrinos pancreáticos no funcionantes (TNEP-Nf). No lograr diferenciarlos preoperatoriamente amerita cirugía. Presentación del caso: paciente femenino de 46 años con dolor abdominal crónico y con tumor de 1.9 cm reportado por tomografía, ubicado en la cola del páncreas, que se llevó a resección pancreática distal con preservación esplénica asistida por robot con éxito. Al año de seguimiento posoperatorio no presentó complicaciones ni insuficiencia endocrina ni exocrina. Se diagnosticó BAIP mediante el reporte de histopatología. Conclusiones: este caso describe el abordaje diagnóstico y terapéutico de una patología muy poco frecuente como el BAIP. No diferenciar un BAIP de un TNEP-Nf por estudios de imagen es indicativo de tratamiento quirúrgico para evitar progresión de tumores malignos.Palabras clave: bazo accesorio intrapancreático, tumor neuroendocrino pancreático no funcionante, pancreatomía distal robótica.
Introducción: la causa más común de obstrucción intestinal posterior a bypass gástrico en Y de Roux es la herniación interna y se puede resolver mediante abordaje laparoscópico. El objetivo de este trabajo es presentar tres causas inusuales de obstrucción intestinal en pacientes bariátricos que se pueden resolver mediante abordaje de mínima invasión. Reporte de casos: el primer caso presenta una paciente de 31 años con antecedente de bypass gástrico en Y de Roux tres años antes que se presentó con síndrome oclusivo. Se diagnosticó intususcepción que se manejó exitosamente con laparoscopía. El segundo caso es una paciente de 37 años a quien se colocó balón gástrico un año previo a la admisión, quien no se presentó a retiro del balón a los seis meses, acude a hospital con cuadro oclusivo, diagnosticándose impactación distal del balón el cual se extrajo con éxito vía laparoscópica. Último caso, se trata de una paciente de 39 años con historia de bypass gástrico en Y de Roux nueve años previos al ingreso con síndrome oclusivo. En la laparoscopía se encontró fitobezoar de 8 cm impactado en el íleon terminal. Se extrajo manualmente utilizando un separador desechable de 5 cm a través del ombligo. Resultados: dos casos se resolvieron por vía laparoscópica y el tercero se extrajo de manera extracorpórea, pero con abordaje lapa- ABSTRACT Introduction: the most common cause of intestinal obstruction after Roux-en-Y gastric bypass (RYGB) is internal herniation and can be resolved by laparoscopic approach. The objective of this paper is to present three unusual causes of intestinal obstruction in bariatric patients that can be resolved by a minimally invasive approach.Report of cases: The first case presents a 31-year-old patient with a history of Roux-en-Y gastric bypass 3 years previously who presented with an occlusive syndrome. An intussusception was diagnosed and successfully managed with laparoscopy. The second case is a 37-yearold patient who had a gastric balloon placed 1 year prior to admission, who did not attend withdrawal at 6 months, goes to the hospital with an occlusive picture, diagnosing distal impaction of the balloon, which was successfully extracted laparoscopic route. Last case, a 39-yearold patient with a history of Roux-en-Y gastric bypass 9 years prior to admission with occlusive syndrome. Laparoscopy revealed an 8 cm impacted phytobezoar in the terminal ileum. It was manually removed using a 5 cm disposable retractor through the umbilicus. Results: two cases were successfully resolved laparoscopically and the third was extracted extracorporeally, but with a laparoscopic approach. No patient
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