Post Roux-En-Y Gastric Bypass Chronic Abdominal Pain with Multiple Intra-Operative Causes: Video Case- Report
Received: 26-Aug-2022 / Manuscript No. JOWT-22- 72960 / Editor assigned: 27-Aug-2022 / PreQC No. JOWT-22- 72960 (PQ) / Reviewed: 10-Sep-2022 / QC No. JOWT-22- 72960 / Revised: 15-Sep-2022 / Manuscript No. JOWT-22- 72960 (R) / Published Date: 22-Sep-2022 DOI: 10.4172/2165-7904.1000512
Abstract
Post-Roux-en-Y (RY) gastric bypass abdominal pain can be due to a diversity of reasons. This complication is under-reported and sometimes hard to diagnose. We present a video case with possible causes and their management.
Keywords
Roux-en-Y gastric bypass; Chronic abdominal pain; Internal hernia; Cabdy cane syndrome
Introduction
Roux-en-Y gastric bypass (RYGB) is the gold standard in bariatric surgery [1]. Post- operative weight loss, co-morbidity resolution and quality of life (QoL) factors following RYGB have been thoroughly reported [2]. However, postoperative chronic abdominal pain is underresearched in the literature [3]. A large study of 1429 patients showed that abdominal pain is the most common symptom (34%) for patients who contact their treating bariatric teams for assistance [2,4]. Possible causes are cholelithiasis, anastomotic ulcers, internal hernia and candy cane syndrome [5–8].
We present a video case of post-RYGB chronic abdominal pain where we found some of these causes intra-operatively. Furthermore, we conducted surgical management to ensure the complete resolution of symptoms afterwards.
Case Report
A 49-year-old woman who had a RYGB in 2011 with a biliopancreatic limb of 60 cm and an alimentary limb of 120 cm. Her initial body mass index (BMI) on the day of surgery was 43.2 kg/m2, and her BMI upon examination in this study was 32 kg/m2. She has had regular followups after surgery. Two years ago, her left-upper-quadrant and central abdominal pain became intolerable. The pain was colicky in nature, was associated with bloating and was aggravated by eating. She denied any symptoms of reflux or diarrhoea but had always complained of some dyspepsia.
She underwent esophagogastroduodenoscopy, which showed a small pouch about 6 cm in length, a wide gastrojejunostomy with no ulceration and a 5 cm hockey stick. A gastrografin study and computed tomography (CT) scan of the abdomen with oral and IV contrast revealed no clear abnormalities.
A diagnostic laparoscopy was performed, and the finding was a 6 cm candy cane at the gastrojejunostomy which was amputate using linear stapler. A 5 cm blind end found at the jejunojejunostomy resected using linear stapler. A wide-open Petersen’s and a smallm esenteric defect found during the jejunojejunostomy were present with no internal herniation. Both defects were closed using 0-0 non-absorbable sutures. In addition, the omental adhesion band in the lower abdomen was taken down, and there was about a 2cm defect in the anterior abdominal that was closed with a 0-0 non-absorbable suture intracorporeally and using the transfascial closing device.
Recovery was uneventful, and she was discharged on postoperative day 1. She was followed up with at the clinic 4 months later, and her abdominal pains had resolved.
Conclusion
Post-RYGB non-specific chronic abdominal pain might be difficult to diagnose [9]. The deferential diagnoses include candy cane syndrome, open mesenteric defects with intermittent internal hernia and blind syndrome [5,7,8]. We believe the surgical technique during primary surgery plays a role in the prevention of such causes. Diagnostic laparoscopy should be considered, especially if investigations show no abnormalities.
Approvals
IRB approval was obtained.
Consent from the patient was obtained.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
- Angrisani L, Santonicola A, Iovino P, Formisano G, Buchwald H, et al. (2015) Bariatric surgery worldwide 2013. Obesity Surg 25(10): 1822-32.
- Hogestol I, Chahal-Kummen M, Eribe I, Brunborg C, Stubhaug A, et al. (2016) Chronic abdominal pain and symptoms 5 years after gastric bypass for morbid obesity. Obesity Surg 27(6): 1438-45.
- Chahal-Kummen M, Blom-Hogestol I, Eribe I, Klungsøyr O, Kristinsson J, et al. (2019) Abdominal pain and symptoms before and after Roux‐en‐Y gastric bypass. BJS Open 3(3): 317-26.
- Gribsholt S, Pedersen A, Svensson E, Thomsen R, Richelsen B (2016) Prevalence of self-reported symptoms after gastric bypass surgery for obesity. JAMA Surg 151(6): 504.
- van Olst N, van Rijswijk A, Mikdad S, Schoonmade L, van de Laar A, et al. (2021)Long-term emergency department visits and readmissions after laparoscopic Roux-en-Y gastric bypass: A systematic review. Obesity Surg 31(6): 2380-90.
- Wanjura V, Sandblom G, Osterberg J, Enochsson L, Ottosson J, et al. (2017) Cholecystectomy after gastric bypass—incidence and complications. Surg Obes Relat Dis 3(6): 979-87.
- Aghajani E, Nergaard B, Leifson B, Hedenbro J, Gislason H (2017) The mesenteric defects in laparoscopic Roux-en-Y gastric bypass: 5 years follow-up of non-closure versus closure using the stapler technique. Surg Endosc 31(9): 3743-8.
- Cartillone M, Kassir R, Mis T, Falsetti E, D’Alessandro A, et al. (2020) Konig's syndrome after Roux-en-Y gastric bypass: Candy cane twist. Obesity Surg 30(8): 3251-2.
- Decker G, DiBaise J, Leighton J, Swain J, Crowell M (2020) Nausea, bloating and abdominal pain in the Roux-en-Y gastric bypass patient: More questions than answers. Obesity Surg 17(11): 1529-33.
Indexed at, Google Scholar, Crossref
Indexed at, Google Scholar, Crossref
Indexed at, Google Scholar, Crossref
Indexed at, Google Scholar, Crossref
Indexed at, Google Scholar, Crossref
Indexed at, Google Scholar, Crossref
Indexed at, Google Scholar, Crossref
Indexed at, Google Scholar, Crossref
Citation: Alotaibi F, Khogeer A, Adamo M, Elkalaawy M (2022) Qpost Roux-En-Y Gastric Bypass Chronic Abdominal Pain with Multiple Intra-Operative Causes: Video Case- Report. J Obes Weight Loss Ther 12: 512. DOI: 10.4172/2165-7904.1000512
Copyright: © 2022 Alotaibi F, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Share This Article
Recommended Journals
Open Access Journals
Article Tools
Article Usage
- Total views: 2078
- [From(publication date): 0-2022 - Mar 14, 2025]
- Breakdown by view type
- HTML page views: 1782
- PDF downloads: 296