Fatal Fulminant Pancreatitis After Laparoscopic Gastric Bypass Surgery

Abstract

Current widespread application of laparoscopic techniques in Roux-en-Y gastric bypass (RYGBP) is making surgical safety an increasingly important issue. We report one case that resulted in death due to postoperative fulminant acute pancreatitis after laparoscopic RYGBP was performed when this procedure was still relatively new in China. The patient was a chronically obese 19-year-old male. Weight loss medications had been ineffective, and preoperative body mass index was 40.7. Preoperative examination revealed moderate steatohepatitis. Laparoscopic RYGBP (LRYGBP) was performed. Early manifestations of clinical shock appeared 13 h after the laparoscopic surgery. A second laparoscopic examination showed small-vessel hemorrhage at the posterior wall of the jejunojejunal anastomosis, with blood clot formation resulting in Roux limb and afferent loop obstruction. Fulminant acute pancreatitis developed in the patient 18 h after the second surgery. The patient died 15 days later from systemic multiorgan insufficiency. LRYGBP (postcolon) is a technically demanding procedure for surgeons who are not experienced in this operation. In addition, surgical tolerance is reduced in morbidly obese patients. Therefore, special care should be taken during surgery, and hemostasis must be achieved at all bleeding sites. Increased perioperative surveillance allows for early detection and management of severe complications.

Managing medical and surgical disorders after divided Roux-en-Y gastric bypass surgery

“…54,55 Esophageal perforation can be identified either in the cervical esophagus or distal esophagus, and is related to intraoperative intubation or intraoperative endoscopy. Other unusual postoperative complications include the development of acute pancreatitis 56,57 (consider obstruction of the biliopancreatic limb of the Roux-en-Y reconstruction 58 or sphincter of Oddi dysfunction) and perforation of a duodenal ulcer, which supports preoperative evaluation for the presence of H. pylori in those patients with history of duodenal ulcer and those who live in a high prevalence region.…”

Laparoscopic obesity surgery in an Asian Institute: A 10‐year prospective study with review of literature

“…LRYGB, regarded as the gold standard of bariatric surgery, was introduced into Taiwan in 2000 (13) and has subsequently proven to be a more effective but complicated bariatric surgery than LVBG (23). Recently, LRYGB has also been developed in Japan, Korea, the Philippines, Malaysia and China (13,(33)(34)(35)(36)(37). Another simplified gastric bypass, LMGB, first reported by Rutledge, was also introduced into Taiwan in 2001 (17).…”

Pancreatitis following bariatric surgery

“…The pancreatitis occurred 31 h after the procedure. A laparoscopy showed a blood clot in the jejunojejunostomy, causing obstruction of the alimentary and biliary limb [9]. A case report described acute pancreatitis after a Roux-en-Y gastric bypass due to reflux into the biliairy limb, however diagnostics did not show any sign of small bowel obstruction [10].…”