Small bowel obstruction secondary to intraluminal bleeding after Roux-en-Y gastric bypass

Area of Science:

• Bariatric Surgery
• Gastroenterology
• Surgical Complications

Background:

• Small bowel obstruction (SBO) is a recognized complication following Roux-en-Y gastric bypass (RYGB).
• Intraluminal bleeding (ILB) leading to hemobezoar formation is an infrequent cause of SBO post-RYGB.
• ILB-related SBO typically manifests within 72 hours post-surgery and can be influenced by anticoagulation or NSAID use.

Purpose of the Study:

• To report a rare case of early SBO caused by ILB and hemobezoar formation after robotic-assisted RYGB.
• To emphasize the importance of timely diagnosis and surgical management for ILB-related SBO.
• To highlight potential complications and their management in the post-operative period.

Main Methods:

• Case presentation of a 41-year-old female with prior sleeve gastrectomy undergoing robotic-assisted RYGB.
• Clinical assessment including symptoms of abdominal pain, distention, and tachycardia.
• Diagnostic imaging with computed tomography (CT) to identify SBO and intraluminal contents.
• Surgical intervention involving emergency re-exploration, enterotomy, and clot evacuation.

Main Results:

• The patient presented with early post-operative SBO attributed to a consolidated hematoma.
• Surgical management via enterotomy and clot evacuation successfully relieved the obstruction.
• Anastomotic revision was not required.
• Post-operative recovery was complicated by an intra-abdominal abscess, managed percutaneously.

Conclusions:

• Intraluminal bleeding should be considered in the differential diagnosis of early SBO after RYGB.
• Prompt CT imaging and surgical intervention are essential to prevent bowel ischemia, perforation, or anastomotic complications.
• This case underscores the need for vigilance in recognizing and managing rare causes of SBO post-bariatric surgery.