Adult small bowel anterograde intussusception post-SAGB: leiomyoma as lead point

We report a rare presentation of anterograde small bowel intussusception post-single anastomosis gastric bypass (SAGB). Small bowel intussusception is a recognised and potentially serious complication of Roux en Y gastric bypass surgery where the jejuno-jejunal anastomosis acts as a lead point and there is retrograde intussusception of the biliary-pancreatic limb proximally. Intussusception post-SAGB is considered far less likely given the absence of a jejuno-jejunal anastomosis. In this case, histopathological examination revealed a submucosal leiomyoma that was not visible on pre-operative imaging. This case highlights that small bowel intussusception can also occur post-SAGB and a high degree of suspicion for a benign lead point is required to avoid potentially serious complications. Furthermore, as a tumour entity is more likely to be the cause of the intussusception, small bowel resection should be considered. In the case presented here, an urgent small bowel resection was undertaken with excellent clinical outcomes.