Intussusception After Bariatric Surgery
Nuria Martinez Sanz
Francisco Miguel González Valverde
Received: 6 May 2018 / Accepted: 9 May 2018
2018 The Society for Surgery of the Alimentary Tract
A case of bowel intussusception in a 43-year-old woman with a history of Roux-en-Y gastric bypass surgery is presented.
Keywords Roux-en-Y gastric bypass
Small bowel intussusception after laparoscopic Roux-en-Y
gastric bypass (LRYGB) is a rare but significant event with
a reported incidence of about 0.1–0.3%.
A 43-year-old woman with a retrograde intussusception
3 years after a LRYGB is presented. She had lost 50% of
excess weight. She complained of paroxysmal, severe abdom-
inal pain as well as nausea and vomiting although, on exam-
ination, no peritoneal signs were present. Laboratory data
were unremarkable. Abdominal contrast-enhanced computed
tomography (CT) showed a Btarget sign^ mass consistent with
small bowel intussusception (Figs. 1 and 2). An emergent
laparoscopy was performed, finding a jejunal-jejunal intussus-
ception located 40 cm from the gastrojejunal anastomosis, at
the alimentary loop (Fig. 3).
A reduction of the intussusception was achieved. No or-
ganic lesion causing the disease was found, and resective pro-
cedures were not necessary because no signs of intestinal dis-
tress were present.
A gastroduodenoscopy and a double-balloon enteroscopy
were performed without pathological findings. After 2 years
of surgery, the patient remains asymptomatic.
Clinical presentation is not specific. CT of the abdomen
with contrast is the diagnostic test of choice, with an accuracy
of 80%. Pathognomonic findings include a Btarget sign^
(Fig. 1). Treatment remains controversial but an early identifi-
cation and surgical intervention seems to reduce morbidity and
prevents recurrence. Laparoscopic approach is the treatment of
choice and most cases are resolved with simple reduction if the
small bowel is viable, with or without enteropexy.
The origin of intussusception after gastric bypass is differ-
ent from that of intussusception of other causes, in that there is
usually no lead point. Peristalsis disturbances in the divided
small bowel, especially in the Roux limb, have been proposed
as a pathophysiological mechanism, but the origin appears to
be multifactorial. The ultimate causes of intussusception after
bariatric surgery still remain unclear.
Familiarity with this
Fig. 1 Abdominal computed tomography scan with oral and intravenous
contrast showing the pathognomonic Btarget sign^
* Francisco Miguel González Valverde
Reina Sofía General University Hospital, University of Murcia,
Department of Surgery, University of Murcia, C/ Victorio no, 3, 20 C,
30003 Murcia, Spain
Journal of Gastrointestinal Surgery