Recent Topics
Medical Bracelet
Deana_ · 0 replies · 13 views
Celebrate vitamins
Deana_ · 3 replies · 37 views
a year after wls
Alain Hebert · 0 replies · 25 views
Frustrated need ideas
Lisa-808 · 8 replies · 139 views
The metaphysical approach
bubbles23223 · 8 replies · 119 views

Intussusception - A Long Term Post Op RNY Complication

So Blessed!
on 5/5/11 7:06 am, edited 5/5/11 1:26 pm
 FYI

Intussusception (in-tuh-suh-SEP-shun) is a serious disorder in which part of the intestine — either the small intestine or colon — slides into another part of the intestine. This "telescoping" often blocks the intestine, preventing food or fluid from passing through. Intussusception also cuts off the blood supply to the part of the intestine that's affected.

Illustration showing intussusception

http://www.mayoclinic.com/health/intussusception/DS00798
 

So Blessed!
on 5/5/11 7:34 am, edited 5/5/11 8:07 am



Intussusception after Roux-en-Y gastric bypass for morbid obesity: case report and literature review of rare complication

Presented as a Poster Presentation at the 23rd Annual Meeting of the American Society for Bariatric Surgery, June 26, 2006, San Francisco, California.

Michael A. Edwards M.D.a, Ronit Grinbaum M.D.a, James Ellsmere M.D.a, Daniel B. Jones M.D.a and Benjamin E. Schneider M.D.Corresponding Author Contact Information, a, E-mail The Corresponding Author

 

aDepartment of Surgery, Harvard University Medical School and Department of Surgery, Section of Minimally Invasive Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts

Received 22 February 2006;  revised 5 April 2006;  accepted 20 April 2006.  Available online 16 July 2006.
     

Abstract

Obstruction of the small intestine is a recognized complication after Roux-en-Y gastric bypass surgery for morbid obesity. Reported causes after bariatric surgery include volvulus, adhesion, internal hernia, hemorrhagic bezoar, incarcerated ventral hernia, and intussusception. Intussusception after Roux-en-Y gastric bypass for morbid obesity is rare. The etiology remains largely obscure. A delay in the diagnosis and management may result in catastrophic outcomes. Management should include the early involvement of a bariatric surgeon. We describe the clinical and radiologic presentation of a case of jejunojejunal intussusception 4 years after open Roux-en-Y gastric bypass.

 

Keywords: Morbid obesity; Roux-en-Y gastric bypass; Small bowel obstruction; Intussusception

So Blessed!
on 5/5/11 7:35 am


Am Surg. 2004 Jan;70(1):67-70.

Antiperistaltic (retrograde) intussusception after Roux-en-Y gastric bypass.

Goverman J, Greenwald M, Gellman L, Gadaleta D.

Source

Department of Surgery, North Shore Long Island Jewish Health Care System, North Shore University Hospital, Manhasset, New York, USA.

Abstract

Adult intussusception has been described after various types of gastrointestinal surgery. In some instances there may be intussusception of the jejunum into the stomach via a gastrointestinal stoma, a rare complication known as jejunogastric intussusception (JGI). We present a retrospective review of two cases of retrograde intussusception occurring years after open Roux-en-Y gastric bypass (RYGB) for morbid obesity. To our knowledge there have been no documented reports of JGI occurring after RYGB and only scattered reports of JGI after Roux-en-Y reconstruction in general. Two reports of intussusception following RYGB were identified in the English literature and comprised three patients, only one of whom suffered a retrograde intussusception. As the number of RYGB procedures continues to rise, we will likely see more of this entity; and it is therefore crucial that surgeons consider acute and chronic intussusception as a cause of abdominal pain in patients who have undergone RYGB.

So Blessed!
on 5/5/11 7:38 am, edited 5/5/11 8:06 am

Retrograde Intussusception following Roux-en-Y Gastric Bypass

Kyle Ver Steeg

 

Obesity Surgery Volume 16, Number 8, 1101-1103, DOI: 10.1381/096089206778026433

Abstract

A case of retrograde intussusception is presented occurring >1 year following a Roux-en-Y gastric bypass (RYGBP). Presentation may be confusing and lead to a serious delay in diagnosis. Review of the literature shows most intussusceptions following RYGBP are retrograde, and most, if not all, appear to originate in the proximal common channel, as ours clearly did. The average excess body weight loss in these patients is much higher than expected, adding evidence that a dysmotility disorder is involved. A hypothesis is presented regarding the mechanism involved in these retrograde intussusceptions.

 
So Blessed!
on 5/5/11 7:42 am


  Surgery for Obesity and Related Diseases
Volume 4, Issue 1, January-February 2008, Pages 69-72


Small bowel obstruction due to antegrade and retrograde intussusception after gastric bypass: three case reports in two patients, literature review, and recommendations for diagnosis and treatment

David D. Coster M.D.Corresponding Author Contact Information, a, Stephen M. Sundberg M.D.a, David S. Kermode D.O.a, Donald T. Beitzel P.A.C.a, Stefanie H. Noun P.A.C.a and Matthew Severidt M.D.a

 

a Grinnell Bariatrics and Department of Surgery, Grinnell Regional Medical Center, Grinnell, Iowa

Received 7 June 2007;  revised 15 July 2007;  accepted 24 August 2007.  Available online 5 November 2007.
     

Abstract

Intestinal obstruction due to intussusception, although rare, is a complication that can cause small bowel obstruction after Roux-en-Y gastric bypass. Possible causes include disordered intestinal motility, the presence of staple lines and other lead points in the intestinal wall, and the anatomic peculiarities of the enteroenterostomy. In the case of antegrade intussusception, the lead point is usually identifiable and can involve either limb. Retrograde intussusception is more common but usually has a featureless entry point beginning a few inches below the intestinal anastomosis, with the intussusceptum traversing the enteroenterostomy into either the biliary or Roux limb. Abdominal computed tomography scan is necessary for diagnosis, and early exploration is recommended to avoid ischemia and bowel resection.

 

Keywords: Small bowel obstruction; Roux-en-Y gastric bypass; Antegrade intussusception; Retrograde intussusception

So Blessed!
on 5/5/11 7:43 am

References

[1] K. Ver Steeg, Retrograde intussusception following Roux-en-Y gastric bypass, Obes Surg 16 (2006), pp. 1101–1109.

[2] M.A. Edwards, R. Grinbaum, J. Ellsmere, D.B. Jones and B.E. Schneider, Intussusception after Roux-en-Y gastric bypass for morbid obesity: case report and literature review of rare complication, Surg Obes Relat Dis 2 (2006), pp. 483–489. Article | PDF (407 K) | View Record in Scopus | Cited By in Scopus (27)

[3] A. Lewis, A 37-year old with vomiting and severe left-sided abdominal pain 3 years after gastric bypass surgery, J Emerg Nurs 32 (2006), pp. 48–50. Article | PDF (60 K) | Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (5)

[4] J. Majeski and D. Fried, Retrograde intussusception after Roux-en-Y gastric bypass surgery, J Am Coll Surg 199 (2004), pp. 988–989. Article | PDF (120 K) | View Record in Scopus | Cited By in Scopus (20)

[5] J. Goverman, M. Greenwald, L. Gellman and D. Gadaleta, Antiperistaltic (retrograde) intussusception after Roux-en-Y gastric bypass, Am Surg 70 (2004), pp. 67–70. View Record in Scopus | Cited By in Scopus (24)

[6] J. Bocker, J. Vasile, J. Zager and E. Goodman, Intussusception: an uncommon cause of postoperative small bowel obstruction after gastric bypass, Obes Surg 14 (2004), pp. 116–119. Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (23)

[7] T.M. Duane, S. Sohlgemuth and K. Ruffin, Intussusception after Roux-en-Y gastric bypass, Am Surg 66 (2000), pp. 82–84. View Record in Scopus | Cited By in Scopus (34)

[8] K. Norton, W. Brown and L. Johnson, Roux-en-Y limb intussusception: two case reports and a review of the literature, J Louisiana State Med Soc 155 (2003), pp. 57–58. View Record in Scopus | Cited By in Scopus (4)

[9] M.P. Hocking, D.M. McCoy, S.B. Vogel, J.V. Kaude and C.A. Sninsky, Antiperistaltic and isoperistaltic intussusception associated with abnormal motility after Roux-en-Y gastric bypass: a case report, Surgery 110 (1991), pp. 109–112. View Record in Scopus | Cited By in Scopus (30)

[10] D.G. Begos, A. Sandor and I.M. Modin, The diagnosis and management of adult intussusception, Am J Surg 173 (1997), pp. 88–94. Abstract | PDF (881 K) | View Record in Scopus | Cited By in Scopus (206)

[11] A. Onopchenko, Radiological diagnosis of internal hernia after Roux-en-Y gastric bypass, Obes Surg 15 (2005), pp. 606–611. Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (27)

[12] B.L. Nguyen Tu and K. Kelly, Motility disorders after Roux-en-Y gastrojejunostomy, Obes Surg 4 (1994), pp. 219–226. Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (13)

[13] M.S. Srikanth, T. Keskey and S.R. Fox, Computed tomography in small bowel obstruction after open distal gastric bypass, Obes Surg 14 (2004), pp. 811–822. Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (23)

[14] B. Kirshtein, A. Roy-Shapira, L. Lantsberg, E. Avinoach and S. Mizrahi, Laparoscopic management of acute small bowel obstruction, Surg Endosc 19 (2005), pp. 464–467. Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (42)

[15] N.H. Chou, N.S. Chou and K.T. Mok, Intestinal obstruction in patients with previous laparotomy for non-malignancy, J Chin Med Assoc 68 (2005), pp. 327–332. Abstract | PDF (93 K) | View Record in Scopus | Cited By in Scopus (4)

(deactivated member)
on 5/5/11 7:57 am - North Brookfield, MA
Hi, I was diagnosed with this a month ago and will be headed for surgery to correct it shortly.
Glad you posted this, thank you
So Blessed!
on 5/5/11 8:03 am

I think it is more common than they realize, but is being misdiagnosed.

Good luck with your surgery!
So Blessed!
on 5/5/11 8:22 am
I did a search on OH and found these too.




  • intussusception 7 years after rny

    I have been on this board b4 but not for several yers and could not remember my
    login or password. I had lap rny 7 years ago, ...

    www.obesityhelp.com/forums/complicati...
  • Question about Intussusception... Am I a Ticking Time Bomb?

    Feb 3, 2011 ... Hello All... I haven't been to these forums in years but am coming here for
    guidance after having my Gastric Bypass in July of 2007.

    www.obesityhelp.com/forums/rny/431580...
  • Severe complication 7 years after RNY surgery

    Oct 3, 2010 ... An intussusception is like a telescoping of one section of bowel into ...
    Intussusception is most common in infants and children under the ...

    www.obesityhelp.com/forums/rny/425027...
  • View - ObesityHelp - Gastric Bypass, LAP-BAND® System, DS and Other

    Mar 29, 2008 ... intussusception. I am 5 1/2 yrs post op with NO complications ever til ...
    Intussusception is rare in adults; does he have any idea what is ...

    www.obesityhelp.com/morbidobesity/inf...
  • Severe abdominal pain

    I had surgery may 7, and i had intussusception. now i am still having ... I feel
    like i am being blown off. what if the intussusception is ...

    www.obesityhelp.com/forums/complicati...
  • Intussesception

    Ultrasonographic evidence of intestinal intussusception was found in 15 patients
    (19%). Two of these patients were asymptomatic. ...

    www.obesityhelp.com/forums/wls_grads/...
  • Know the Risks of Intestinal Blockage

    Jul 21, 2008 ... The most common causes of small intestine obstruction are adhesions, hernias and
    tumors, but also may include intussusception, volvulus and ...

    www.obesityhelp.com/ohblog/mode,conte...
(deactivated member)
on 5/5/11 11:47 am - North Brookfield, MA
Thank you for the info, I appreciate it.

My surgeon was waiting to see if it would resolve on it's own.  I am not vomiting, no fever.
I have constipation or more like I can still go but it feels like my system is in slow motion or something. Like I never feel 'done' really but can't go anymore? Sorry for TMI but you never know who you might help by telling your story. Low back pain, and I notice the left upper quad pain gets worse when I am more constipated.  I see the surgeon in a week so we shall see...

So Blessed!
on 5/5/11 11:59 am

One of the most interesting pieces of information that I got from the surgeon was that the stomach has two rhythmic “pacemakers”.  They’re similar to those in the heart in that they stimulate the muscles to contract.  

In a normal stomach, the waves propagate in one direction, pushing the food downward.  After we have R&Y, however, the lower pace-making node is no longer connected to the other and fires independently.  The peristalsis it creates can actually go BACKWARDS in some people.  This explained why the pain that I felt would peak and then subside a little bit.  

 

I thought I knew about all the possible complications, but this one caught me totally off guard.

I've noticed no correlation between pain episodes and having to go to the bathroom.  When my abdominal pain was at its worst, I did have bad lower back pain too.

MsBatt
on 5/5/11 2:16 pm
Where are these two nodes located, in pre-op anatomy?
So Blessed!
on 5/6/11 5:25 am

   MsBatt,

In the diagram that he drew for me, it looked like one was in the fundus area of the stomach and the other near the duodenum.  I'd always been taught that peristalsis was just a reflex caused by the gut being stretched.  I'm trying to learn more about this myself as this is new to me. 

Google "Interstitial Cells of Cajal" - it's fascinating.  


MsBatt
on 7/29/11 9:45 pm
What were your symptoms? I'm assuming they're different from a 'regular' bowel obstruction, since there's no WAY you could live with the symptoms of an obstruction for a month.
vervetoloose
on 5/5/11 8:07 am
Intussusception can compromise the circulation to the bowel wall. May I ask why they are waiting to repair this? Maybe I am misunderstanding.....


            

" Oh you who love clear edges more than anything...........watch the edges that blurr."
 
So Blessed!
on 5/5/11 8:13 am

Sometimes the intestine slides back out on its own, so the imminent danger passes.  If not, the patient has to undergo emergency surgery.

Gloria-Caryl
on 5/5/11 8:30 am
Wow, who would know, thanks
So Blessed!
on 5/5/11 8:57 am

It's spooky.  I'd been having intermittent bouts of abdominal pain for years and never knew what was causing it.
Dionysus
on 5/5/11 9:00 am
Sorry you're going through that.
So Blessed!
on 5/5/11 9:45 am

All's been quiet since I had to go to the ER.  I'm hoping it stays that way.