Pregnant patient with acute abdominal pain and previous bariatric surgery

In the literature, midgut volvulus is a well-known surgical complication following gastric bypass surgery that is serious and necessitates an immediate intervention. Here, we report a case of internal herniation that was misdiagnosed twice but eventually managed appropriately. A 27-year-old male with a surgical history of Roux-en-Y gastric bypass came to the emergency department complaining of severe epigastric abdominal pain. Two months earlier, he had a similar pain which was treated with Helicobacter pylori eradication therapy. Despite completing the eradication therapy, the pain reoccurred. Computed tomography angiography showed a filling defect in the superior mesenteric artery that was followed by a diagnostic laparoscopy ending with internal hernia reduction. Physicians should consider internal herniation as a differential diagnosis for every patient with a history of gastric bypass surgery presenting with abdominal pain.

Section: Discussionmentioning

confidence: 99%

Midgut Volvulus Evolving From Internal Herniation Following Roux-en-Y Gastric Bypass Surgery

Alotaibi,

Alharbi,

Alanazi

et al. 2023

“…The laparoscopic repair of ventral hernia appears to be safe before and during pregnancy, without any significant impact on the pregnancy and delivery course. The laparoscopic approach also appears to be a safe process for treating BS complications during pregnancy, such as the laparoscopic management of IH after laparoscopic Roux-en-Y gastric bypass (LRYGB) [22,23]. The open approach may be offered in cases involving complicated hernia, thin patients, and large hernia size.…”

Section: Laparoscopic Versus Open Approachmentioning

confidence: 99%

How to Treat Hernias in Pregnant Women?

Danawar

Mekaiel

Raut

et al. 2020

A hernia is a common surgical problem. Although hernias during pregnancy are uncommon, they can be challenging for both the surgeon and the patient if present. To date, there is no consensus in the medical community regarding the elective repair of hernias in pregnant women. The debate mainly concerns three areas: the timing, the approach, and the surgical technique. This study aims to offer a clear pathway in this field based on the best available data. In this study, we collected reviews written in English and published in PubMed from 2010 to 2020 (the exception being three articles that were published before 2010, which we retained since they contained relevant information). We used regular and Medical Subject Headings (MeSH) keywords. Two of the authors screened the collected studies to select the best articles that would fit our inclusion criteria for the review. The articles considered for this review can be classified into retrospective studies, case reports, and reviews. No randomized controlled trials were found.

“…For the newborn, there is an increased risk of being small or large for gestational age, pre-term or post-term pregnancy, congenital anomalies such as neural tube defects, and perinatal mortality [ 1 , 2 ]. Weight loss following bariatric surgery reduces cardiovascular risks, improves fertility, and reduces obesity-related complications during pregnancy [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, bariatric surgery is the most effective treatment for long-term weight loss; most surgeries are performed on women of reproductive age [ 1 ]. However, bariatric surgery also carries long-term complications, with an increased risk of severe maternal and fetal morbidity and mortality [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Petersen’s Hernia in a Pregnant Woman Following Roux-en-Y Gastric Bypass Surgery: The Importance of Emergency Surgical Treatment

Calderón Espinosa de los Monteros,

Castro Segovia,

Arciniega Belmont

2024

Roux-en-Y gastric bypass (RYGB) patients are at risk of creating potential spaces for possible internal hernias during the procedure. During pregnancy, the pregnant uterus elevates the bowel, increasing intra-abdominal pressure. Cases reported to date have described mild abdominal pain and no evidence of peritoneal irritation, with inconclusive ultrasound and MRI findings for diagnosis of Petersen's hernia. We present the case of a 42-year-old female patient with a history of RYGB eight years earlier without complications, with a pregnancy of 34 weeks of gestation. Symptomatology began with colicky abdominal pain in the epigastric, with irradiation to the right upper quadrant. On physical examination, revealed a painful abdomen on the median and deep palpation in the epigastric and right upper quadrant, the rest of the studies were inconclusive. As there was no improvement of the symptoms in 12 hours, an emergency diagnostic laparoscopy was performed, finding a strangulated Petersen's hernia requiring resection, with the closure of the gastric pouch, intestinal anastomosis, and Stamm gastrostomy with closure of the mesenteric gap. Therefore, a pregnant patient presenting with upper quadrant abdominal pain with a history of RYGB, even one with normal labs and imaging, should be assumed to have an internal hernia until proven otherwise. The emergency surgical approach is associated with early resolution and prevents its progression with catastrophic results.