Late intestinal intussusception after a Roux in Y gastric bypass surgery

Abstract

Obesity is a major public health problem that has driven the development of various therapeutic strategies. Among these, Roux-en-Y gastric bypass stands out for its effectiveness, although it may be associated with rare but serious complications, such as intestinal intussusception, which is challenging to diagnose due to its nonspecific presentation. Case presentation. A 45-year-old woman with a history of hypothyroidism treated with levothyroxine and a laparoscopic gastric bypass performed two years prior for morbid obesity (body mass index of 49.5 kg/m²), with adequate weight loss. She presented with abdominal pain that had been present for six hours, accompanied by nausea, vomiting, and hematemesis. On physical examination, she was hemodynamically stable, with no signs of peritoneal irritation. Upper gastrointestinal endoscopy revealed no significant findings, while abdominal CT scanning showed proximal jejunal intussusception. Treatment. An exploratory laparotomy was performed, revealing dilation of the jejuno-jejunal anastomosis and approximately 40 cm of necrotic jejunum; consequently, intestinal resection and reconstruction of the anastomosis were performed. Outcome. The postoperative period was complicated by a dynamic ileus, pleural effusion, and a urinary tract infection caused by Escherichia coli. The patient recovered satisfactorily following hospital discharge.