Obstruction of the Bypassed Stomach Treated with Percutaneous Drainage: An Alternative Treatment for Selected Cases

Abstract

Biliopancreatic limb obstruction in Roux-en-Y gastric bypass is an infrequent complication that should be recognized early to avoid the risk of peritonitis and death. In this manuscript, we report a case of acute gastric remnant dilatation secondary to intraabdominal hematoma provoked by trocar injury that was compressing the second portion of duodenum lumen. To treat this problem, we decided on a less invasive treatment consisting of percutaneous decompression of the stomach. The procedure was performed using sonographic guidance with local anesthesia, thus, avoiding a new surgical procedure. In this selected case, percutaneous radiological catheter placement provided an effective decompression of the excluded gastric remnant until spontaneous resolution of the obstruction.

Acute gastric remnant dilatation, a rare early complication of laparoscopic mini‐gastric bypass

“…Acute gastric dilatation is a surgical emergency. It can cause necrosis of the blind‐bypassed distal stomach with subsequent perforation and peritonitis . Although gastric remnant dilatation has been reported in RYGBP , this is the first case, to our knowledge, of acute gastric remnant dilation in LMGB.…”

“…Complications in bariatric surgery patients do not manifest in the same manner as normal‐sized patients; any delay in treating a significant complication reduces a patient's ability to recover . Different procedure‐related complications of LMGB have been reported, including bowel obstruction, major bleeding, respiratory failure, renal failure, anastomotic stricture, marginal ulcer, incisional hernia, bile reflux, iron‐deficiency anemia, and diarrhea .…”

Percutaneous drainage of gastric remnant dilatation after laparoscopic Roux‐en‐Y gastric bypass

“…Patients may present with epigastric pain or fullness, decreased urine output, respiratory distress, and/or shock . A patient may have elevated serum amylase due to pancreatic duct compression.…”