Roux limb obstruction

Case contributed by Dr Bruno Di Muzio

Presentation

Patient in the late postoperative bariatric surgery (7 years), developed sudden small bowel obstruction.

Patient Data

Age: 36
Gender: Female

Upper gastrointestinal (UGI) series

Modality: Barium

Upper gastrointestinal (UGI) series shows dilated loops of proximal small bowel (>3 cm). 

CT Abdomen and pelvis

Modality: CT

The patient underwent bariatric surgery with anterocolic-anterogastric transposition of the Roux loop.

It's possible to observe the distension of the proximal jejunum, fluid content, stacking coins sign, until the portion in mesogastric abdomen, where there is narrowing and abrupt return to normal caliber, coinciding with the point of latero-lateral anastomosis of bariatric surgery.

Case Discussion

Small bowel obstruction are more frequent after laparoscopic gastric bypass than after open procedures. Most obstructions after laparoscopic Roux-en-Y gastric bypass are secondary to internal hernias, with fewer obstructions from post-operative adhesions or other causes.

Small bowel obstruction may occur anywhere and produce varied radiographic appearances.

Roux limb obstructions may be secondary to adhesions, strictures, kinking, internal hernias, or occasionally bezoars or intussusceptions. Patients with Roux limb obstructions typically present with nausea and vomiting, and radiologic evidence of obstruction may be detected at UGI examination or CT.

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Case Information

rID: 14670
Case created: 21st Aug 2011
Last edited: 9th Jun 2016
Inclusion in quiz mode: Included

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