Midgut Volvulus Evolving From Internal Herniation Following Roux-en-Y Gastric Bypass Surgery

In the literature, midgut volvulus is a well-known surgical complication following gastric bypass surgery that is serious and necessitates an immediate intervention. Here, we report a case of internal herniation that was misdiagnosed twice but eventually managed appropriately. A 27-year-old male with a surgical history of Roux-en-Y gastric bypass came to the emergency department complaining of severe epigastric abdominal pain. Two months earlier, he had a similar pain which was treated with Helicobacter pylori eradication therapy. Despite completing the eradication therapy, the pain reoccurred. Computed tomography angiography showed a filling defect in the superior mesenteric artery that was followed by a diagnostic laparoscopy ending with internal hernia reduction. Physicians should consider internal herniation as a differential diagnosis for every patient with a history of gastric bypass surgery presenting with abdominal pain.