Laparoscopic gastric bypass with intestinal malrotation

Area of Science:

• Gastroenterology and Surgical Procedures
• Congenital Anomalies
• Bariatric Surgery

Background:

• Intestinal malrotation is a congenital anomaly affecting approximately 1 in 500 live births.
• While typically diagnosed in infancy, it can remain asymptomatic and undetected until adulthood.
• Adult presentation often occurs incidentally during radiographic or surgical interventions.

Observation:

• This report details a case where intestinal malrotation was identified during a laparoscopic Roux-en-Y gastric bypass (LRYGBP).
• The case highlights the technical considerations required to successfully complete the LRYGBP in the presence of this anomaly.
• A review of existing literature on this rare clinical scenario is also provided.

Findings:

• Incomplete intestinal malrotation was discovered intraoperatively during a LRYGBP procedure.
• The surgical team successfully adapted techniques to manage the malrotation and complete the bariatric surgery.
• Literature review confirms the rarity of this presentation in adult bariatric surgery patients.

Implications:

• The presence of incomplete intestinal malrotation should not be considered an absolute contraindication for performing LRYGBP in patients with morbid obesity.
• Surgeons should be prepared to manage incidental findings of intestinal malrotation during LRYGBP.
• This case contributes to the understanding of managing congenital anomalies in the context of advanced bariatric procedures.