Elevated plasma pancreatic enzyme concentrations after Roux-en-Y gastric bypass may indicate closed loop obstruction

Area of Science:

• Bariatric surgery outcomes
• Gastrointestinal complications
• Obstetric surgery

Background:

• Laparoscopic Roux-en-Y gastric bypass (RYGB) is a prevalent bariatric procedure, frequently performed on women of reproductive age.
• Pregnancy in post-RYGB patients necessitates awareness of potential bariatric-specific surgical complications.
• General surgeons and obstetricians must be vigilant for these risks.

Observation:

• A 32-year-old woman, 2 years status-post RYGB, presented at 25 weeks gestation.
• The patient exhibited symptoms initially misdiagnosed as acute pancreatitis.
• The underlying cause was a closed-loop obstruction from retrograde jejunojejunal intussusception.

Findings:

• Retrograde jejunojejunal intussusception can occur in pregnant patients with prior RYGB.
• Misdiagnosis of bariatric-specific complications is a significant concern.
• Timely diagnosis is crucial for appropriate management.

Implications:

• Highlights the need for increased clinical suspicion for bariatric complications in pregnant patients.
• Emphasizes the importance of multidisciplinary collaboration between bariatric and obstetric teams.
• Suggests potential for improved diagnostic algorithms and patient counseling.