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.
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
Department of Surgery, North Shore Long Island Jewish Health Care System, North Shore University Hospital, Manhasset, New York, USA.
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.
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
 K. Ver Steeg, Retrograde intussusception following Roux-en-Y gastric bypass, Obes Surg 16 (2006), pp. 1101–1109.
 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)
 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)
 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)
 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)
 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)
 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)
 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)
 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)
 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)
 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)
 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)
 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)
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, ...
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.
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 ...
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 ...
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 ...
Ultrasonographic evidence of intestinal intussusception was found in 15 patients
(19%). Two of these patients were asymptomatic. ...
Jul 21, 2008 ... The most common causes of small intestine obstruction are adhesions, hernias and
tumors, but also may include intussusception, volvulus and ...