Jejuno-jejunal intussusception after LRYGBP: Conservative management
Posted in Pictures on 4 October 2016
Gabriel Díaz (Gastrointestinal surgery specialist) Beatriz Martin-Perez (Gastrointestinal surgery specialist) Hospital Clínic, Barcelona – Spain
A 43-year-old female with a previous history of high blood pressure, T2DM, dyslipidemia, hiatal hernia and a laparoscopic cholecystectomy. She suffered from morbid obesity with a BMI of 44.10 Kg/m2. She underwent an uneventful LRYGBP one year and a half ago. She had a weight loss of 23 Kg and her current BMI is 30 Kg/m2. She came to the emergency room with three-day abdominal pain and diarrhea.
Vital signs were stable. During the physical examination she presented with pain and tenderness at the right flank. Blood test revealed 6.25 10^9/L leucocytes and a PCR of 24.99 mg/dL. A CT-Scan was conducted, showing a short segment of proximal ileum that was invaginated, forming a concentric ring image (FIG 1). No change of gauge or pneumoperitoneum were found.
The patient was kept under surveillance with nil by mouth, IV fluids and vital sign monitoring. There were no signs of alarm and PCR levels decreased.
She was discharged on the second day with good tolerance to oral intake, no pain and correct bowel movements. An entero-CT-scan will be performed to clarify the cause.