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Intussusception Following Roux-en-Y Gastric Bypass
Nadeem N. Haddad*, Asad Choudhry, Stephanie Polites, Mohammad A. Khasawneh, Donald H. Jenkins, Michael L. Kendrick
Surgery, Mayo Clinic, Rochester, MN
Objective:
Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed bariatric procedures in the United States; however, it is associated with considerable long term morbidity including intussusception. We hypothesized that a significant proportion of patients who are diagnosed with intussusception after RYGB do not require operative exploration.
Methods:
Following IRB approval, we identified patients with a history of RYGB diagnosed with intussusception at our institution between 2003 and 2015. Data is presented as means ± standard deviation or percentages.
Results:
Of 33 patients with intussusception following RYGB, 31(93.4%) were female and mean age at diagnosis of intussusception was 44.6 ± 11.0 years. Mean time between RYGB and diagnosis of intussusception was 7.9 ± 7.1 years.. The most common presenting symptoms were abdominal pain (75.8%), nausea (30.3%), and vomiting (27.3%) however, 8 were incidental. In total, 48.5% of patients had normal abdominal examinations. Computed tomography was performed in all patients (100%), and was diagnostic of intussusception in 30 patients (90.9%). The most common location of intussusception was enteric (93.9%) and the most common site was at the jejunojejunostomy (41.9%). Transient intussusception was found in 63.6% of cases. Operative exploration was performed in 10 patients (30.3%) while the remaining 23 (69.7%) underwent nonoperative management. Operative exploration was negative in 5 of 10 patients (50%), suggestive of transient intussusception.
Conclusion:
Intussusception as a complication of RYGB is often transient. Strong consideration should be given to non-operative management in the absence of other concerning signs or symptoms.
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