Small-bowel obstruction after laparoscopic roux-en-Y gastric bypass surgery

Gowthaman Gunabushanam, Sridhar Shankar, Donald R. Czerniach, John J. Kelly, Richard A. Perugini

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

PURPOSE: The purpose of this study was to review the etiology and computed tomography (CT) findings of small-bowel obstruction (SBO) in patients who have undergone bariatric laparoscopic Roux-en-Y gastric bypass (LGBP) surgery. MATERIALS AND METHODS: Prospectively entered data from a surgical database of 835 consecutive patients who underwent antecolic-antegastric LGBP for morbid obesity from June 1999 to April 2005 in a single institution were retrospectively reviewed. A total of 42 cases of bowel obstruction were observed in 41 patients. Surgical proof was available in 38 cases, and 4 cases had characteristic imaging features and/or clinical follow-up. Seventeen CT scans were reviewed to determine cause and level of obstruction, and this was correlated with surgical findings and clinical follow-up. RESULTS: Internal hernia was the most common (13 cases) and also the most frequently missed etiology of SBO on CT scans, with the diagnosis being made prospectively in only 2 of 6 cases, in which CT was done. Adhesions, ventral hernia, postoperative ileus, and jejunojejunal (JJ) anastomotic strictures, in that order, were the other commonly observed etiologies for SBO, with 11, 7, 5, and 4 cases, respectively. Some causes of SBO post-LGBP (JJ anastomotic stricture and postoperative ileus) developed relatively early, whereas others (internal hernia) tended to develop later or had a bimodal distribution (adhesions and ventral hernia). Fifteen (36%) of 42 cases had SBO at or near the level of jejunojejunostomy site; causes included internal hernia (5 cases), adhesions/kinking of small bowel (5 cases), JJ anastomotic stricture (4 cases), and JJ intussusception (1 case). CONCLUSION: The time interval between LGBP and development of SBO might provide a useful clinical clue to its etiology. The JJ level is an important location for SBO post-LGBP because of a variety of causes, and special attention must be paid to this site at imaging of post-LGBP patients.

Original languageEnglish (US)
Pages (from-to)369-375
Number of pages7
JournalJournal of Computer Assisted Tomography
Volume33
Issue number3
DOIs
StatePublished - May 1 2009

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Gastric Bypass
Hernia
Tomography
Ventral Hernia
Pathologic Constriction
Ileus
Bariatrics
Intussusception
Morbid Obesity
Databases

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

Cite this

Small-bowel obstruction after laparoscopic roux-en-Y gastric bypass surgery. / Gunabushanam, Gowthaman; Shankar, Sridhar; Czerniach, Donald R.; Kelly, John J.; Perugini, Richard A.

In: Journal of Computer Assisted Tomography, Vol. 33, No. 3, 01.05.2009, p. 369-375.

Research output: Contribution to journalArticle

Gunabushanam, Gowthaman ; Shankar, Sridhar ; Czerniach, Donald R. ; Kelly, John J. ; Perugini, Richard A. / Small-bowel obstruction after laparoscopic roux-en-Y gastric bypass surgery. In: Journal of Computer Assisted Tomography. 2009 ; Vol. 33, No. 3. pp. 369-375.
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