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INTERNAL HERNIA WITH MIDGUT VOLVULUS IN A PATIENT WITH PRIOR LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS
Monika A. Krezalek*, Mustafa Hussain
General surgery, University of Chicago, Chicago, IL



Internal hernia (IH) is a serious complication that can occur at any time following laparoscopic Roux-en-Y gastric bypass (LRYGB).
We present a patient with history of retro-colic LRYGB performed 12 years ago, who presented with severe intermittent abdominal pain. CT scan showed a subtle mesenteric swirl sign. Laparoscopic exploration revealed an IH at the jejuno-jejunostomy mesenteric defect. Small bowel was carefully reduced and mesenteric defect closed.
High degree of suspicion for IH must be maintained in patients with prior LRYGB due to the non-specific symptomatology, high frequency of negative imaging, and potential for catastrophic consequences with delayed/missed diagnosis.


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