Unexpected Twists: Intussusception as a Long Term Sequalae of Bariatric Surgery

Bowel intussusception is rare in adults and accounts for less than 5 % of all cases, occurs in only 1 % of patients with bowel obstruction and in 0.64 % of patients following Roux-en-y bypass surgery with a female predominance. Our case underscores the unusual size and configuration of intussusception, wherein the distal segment telescopes into the proximal segment, defying the conventional presentation. Notably, the rarity of observing intussusception following Roux-en-Y gastric bypass surgery is also highlighted. It is important to be clinically vigilant and keep long term sequalae of bariatric surgery on the differential. A 56-year-old female with a remote history of Roux-en-Y gastric bypass surgery presented with epigastric pain radiating to the lower left and right quadrants, nausea, and vomiting of 1-day duration. She was on a prolonged outpatient course of non-steroidal anti-inflammatory drugs and steroids for pain management following recent orthopedic procedure. In the emergency department, she was afebrile, saturating well on two liters of oxygen, and normotensive with sinus tachycardia. Labs showed leukocytosis with mildly elevated lipase, alkaline phosphatase, and lactic acid. Initial CT abdomen pelvis with contrast was unremarkable. The patient continued to experience abdominal pain with worsening lactic acid. Repeat imaging revealed a 10 cm enteroenteric intussusception containing proximal jejunum with the gastric bypass Roux limb acting as the intussuscipiens. No obvious mass or lead point was identified. Ulceration/stricture at the jejunojejunal anastomosis was thought to be contributory to this. The patient underwent successful laparoscopic surgery.