Presentation
Severe colicky abdominal pain. Past history of gastric bypass surgery with Roux-en-Y loop.
Patient Data
Within the left abdomen, there is a long segment of small bowel intussusception with the upstream small bowel fluid filled and dilated. The intussusceptum is thickened and edematous, and there is a short segment of the intussusceptum that is non-enhancing, representing ischemia/infarction.
Small bowel mesenteric fat and vessels are appreciated being pulled in along with the intussusceptum. No lead point mass is confidently identified. The anastomotic suture ring of the intussuscipiens does not appear to be the lead point.
Evidence of previous gastrojejunostomy and entero-enterostomy. There is a small pocket of free intraperitoneal fluid lying anterior to the point of intussusception. No pneumatosis intestinalis or portal venous gas identified.
Case Discussion
The patient went for emergency laparotomy, which demonstrated the efferent limb of the Roux-en-Y intussuscepting into the afferent limb beyond the entero-enterostomy anastomosis. Approximately 10cm of infarcted small bowel was identified and resected. No focal lead point mass was identified.