Department of Surgery, Hospital Central Militar, Mexico City, Mexico (Drs Flores-Martín, Pereyra-Talamantes, and López-Téllez).

ABSTRACT

Background: Intestinal obstruction is a common late complication of Roux-en-Y gastric bypass surgery, most commonly due to internal herniation or anastomotic strictures. Bezoars are a rare cause of obstruction in this setting, with very few cases reported in literature.

Case Report: The authors present the case of a 39-year-old female patient who underwent a laparoscopic Roux-en-Y gastric bypass for the treatment of severe obesity 9 years before her admission. Initially she weighed 140 kg, her body mass index was 50.8 kg/m2, and she didn’t have any known comorbid conditions. She was admitted to the emergency department at the hospital with abdominal pain, distention, nausea, and vomiting over 20 episodes that started 16 hours before her admission. After workup, a decision was made to perform a laparoscopic exploration. An 8-cm phytobezoar obstructing the common channel of the bypass was found; it was composed mostly of orange fibers and slices. It was extracted via enterotomy.

Results: In the postoperative period the obstructive syndrome was resolved, the patient was started on clear liquids in postoperative day 2 and sent home on postoperative day 5. The instructions were not to ingest large amounts of fiber and chewing on her meals. Her recovery was uneventful.

Conclusion: To the best of the authors’ knowledge there are about 15 reported cases of bezoar formation in patients who underwent Roux-en-Y gastric bypass surgery. As this procedure is more frequently performed worldwide, an increase on these types of cases is expected.

Key Words: Roux-en-Y gastric bypass; Intestinal obstruction; Bezoar; Phytobezoar.

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Department of Surgery, Barnet and Chase Farm Hospitals NHS Trust, Barnet, UK (all authors).

ABSTRACT

Introduction: An intersigmoid hernia is a type of internal hernia and is a rare cause of small-bowel obstruction. It occurs because of a congenital peritoneal defect at the root of the sigmoid mesocolon called the intersigmoid fossa.

Case Description: A case of intersigmoid hernia causing acute small-bowel obstruction is presented and a technique for the laparoscopic management of an incarcerated intersigmoid hernia is described.

Discussion: This is the first reported case of an intersigmoid hernia being repaired by a totally laparoscopic approach and highlights the utility of laparoscopy in acute small-bowel obstruction, particularly when the patient has not had previous abdominal surgery.

Key Words: Intestinal obstruction, Intersigmoid hernia, Laparoscopy.

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