Initially, her condition was managed medically with bowel regimen and diet modification but due to the persistence of her symptoms, she underwent diagnostic laparoscopy to rule out intermittently incarcerating and reducing internal hernia. A computed tomography (CT) of the abdomen was performed which showed no clear evidence of internal hernia. The patient did well for two to three weeks post-surgery but then developed new symptoms of cycles of debilitating left upper quadrant abdominal pain associated with abdominal distention, nausea and difficult bowel movements every four to five-days and relieved by eventual bowel movements. Due to severe recurrence of her intractable gastric reflux symptoms despite maximal medical therapy, the patient then underwent a third bariatric procedure in 2016 with a laparoscopic, antecolic Roux-en-Y gastric bypass.
This is a case of a 31-year-old Caucasian female that presented with a prior history of multiple bariatric surgeries including laparoscopic gastric band placement in 2006 that was converted to a laparoscopic sleeve gastrectomy in 2010 due to gastric reflux symptoms.
We present the first reported case of a large bowel obstruction secondary to a Roux-en-Y gastric bypass including the surgical method used to correct this unusual complication of bariatric surgery. The relatively fixed nature and large caliber of the colon limits the risk of involvement with the mesenteric defects that typically trap and incarcerate the small bowel leading to obstruction. Large bowel obstruction, however, has not been reported in association with gastric bypass surgery. It is therefore a complication that requires a high index of suspicion and a low threshold for early intervention. This feared complication can have devastating consequences, such as long segment of small bowel ischemia, if not identified on time. Small bowel obstruction represents the predominant source of obstructions and is typically due to closed loop obstruction within internal hernias. An established complication of laparoscopic gastric bypass surgery is bowel obstructions with a reported incidence as high as 9.7%. Laparoscopic Roux-en-Y bypass (RYGB) is the approach of choice for bariatric surgical procedures, being performed in the majority of the 200,000 procedures performed in the United States in 2007. We present the interesting case of a patient with large bowel obstruction following laparoscopic Roux-en-Y gastric bypass surgery. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Tafadzwa P Makarawo, Colon and Rectal Surgeon, Colon and Rectal Center of Arizona, USA Colon and Rectal Surgeon, Swedish Colon and Rectal Clinic, 1101 Madison, Suite 510 Seattle, WA 98104, USA, Tel: 1-20, Fax: +1-20, E-mail: Ap| Accepted: Ap| Published: May 02, 2018Ĭitation: Makarawo TP, Bastawrous S, Bastawrous A (2018) Splenic Flexure Mobilization for Subacute Large Bowel Obstruction following Gastric Bypass: A Case Report. Tafadzwa P Makarawo 1,2, Sarah Bastawrous 3 and Amir Bastawrous 2ġColon and Rectal Surgeon, Colon and Rectal Center of Arizona, USAĢColon and Rectal Surgeon, Swedish Colon and Rectal Clinic, USAģDepartment of Radiology, University of Washington School of Medicine, Seattle, WA USA Department of Diagnostic Imaging, VA Puget Sound Health Care System, Seattle, WA USA Splenic Flexure Mobilization for Subacute Large Bowel Obstruction Following Gastric Bypass: A Case Report
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