Small bowel occlusion due to a clot after Roux-n-Y gastric bypass
Posted in Pictures on 4 June 2015
Ainitze Ibarzábal (Gastrointestinal Surgery Senior Specialist)
Mario Pagès (Radiology Consultor)
Hospital Clínic, Barcelona, Spain
A 42-year-old female patient with T2DM and morbid obesity (BMI 42 Kg/m2 – 97 Kg) underwent a laparoscopic Roux-n-Y gastric bypass without incidences. All the anastomoses were mechanical. At the postoperative period she presented nausea, abdominal pain and distention. There was no fever and drainage was serous. The blood test showed a hemoglobin drop (from 13.7 to 11.8 mg/dL) with maintained blood pressure.
A CT-Scan was performed revealing a small bowel occlusion due to clot located distal to the foot of the Roux-n-Y(FIG. 1, red arrow). The clot was producing a significant distension of the gastric remnant (FIG. 1, green arrow). The pouch anastomoses were intact as there as no free air or leak (FIG. 1, yellow arrow). There was no evidence of active bleeding at that time.
Heparin and NSAIDs were suspended. Laparoscopic surgical treatment was performed. An enterotomy and evacuation of the clot were carried out as well as a gastrostomy that was sealed after achieving stomach decompression.
Surgery took 95 minutes. The patient remained stable with a maintained Hb of 10.5 mg/dL. Oral intake was initiated on the second post-operative day and the patient left hospital 4 days after the second surgery.