Internal Hernia and Small Bowel Obstruction After Roux-en-Y Gastric Bypass

Saleh, Adel Alhaj; Abbas, Mujjahid

doi:10.1007/978-3-319-75841-1_13

Cited by 1 publication

(2 citation statements)

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“…Urgent surgical exploration via diagnostic laparoscopy may be warranted even in the absence of concerning imaging findings, especially when there are signs of obstruction or the patient’s pain is severe in nature. When running the bowel, some surgeons recommend starting distally at the ileocecal valve and moving proximally, as the distal decompressed small bowel makes it easier to run and identify relevant anatomy . Each of the potential mesenteric defect sites should be carefully examined.…”

Section: Discussion and Observationsmentioning

confidence: 99%

“…When running the bowel, some surgeons recommend starting distally at the ileocecal valve and moving proximally, as the distal decompressed small bowel makes it easier to run and identify relevant anatomy. 36,37 Each of the potential mesenteric defect sites should be carefully examined. If an internal hernia is present, reduction of the hernia and closure of the defect can usually be performed laparoscopically using permanent suture.…”

Section: Internal Herniamentioning

confidence: 99%

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Abdominal Pain After Roux-en-Y Gastric Bypass

Fry,

Finks

2023

JAMA Surg

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ImportanceRoux-en-Y gastric bypass (RYGB) remains one of the most commonly performed operations for morbid obesity and is associated with significant long-term weight loss and comorbidity remission. However, health care utilization rates following RYGB are high and abdominal pain is reported as the most common presenting symptom for those seeking care.ObservationsGiven the limitations of physical examination in patients with obesity, correct diagnosis of abdominal pain following RYGB depends on a careful history and appropriate use of radiologic, laboratory and endoscopic studies, as well as a clear understanding of post-RYGB anatomy. The most common etiologies of abdominal pain after RYGB are internal hernia, marginal ulcer, biliary disease (eg, cholelithiasis and choledocholithiasis), and jejunojejunal anastomotic issues. Early identification of the etiology of the pain is essential, as some causes, such as internal hernia or perforated gastrojejunal ulcer, may require urgent or emergent intervention to avoid significant morbidity. While laboratory findings and imaging may prove useful, they remain imperfect, and clinical judgment should always be used to determine if surgical exploration is warranted.Conclusions and RelevanceThe etiologies of abdominal pain after RYGB range from the relatively benign to potentially life-threatening. This Review highlights the importance of understanding key anatomical and technical aspects of RYGB to guide appropriate workup, diagnosis, and treatment.

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Section: Discussion and Observationsmentioning

confidence: 99%

Section: Internal Herniamentioning

confidence: 99%