Early small bowel obstruction caused by hemobezoar after Roux-en-Y transit bipartition: a case report

Hemobezoar is a rare cause of early postoperative small bowel obstruction after bariatric surgery, resulting from intraluminal clot formation and anastomotic impaction. Reports involve Roux-en-Y gastric bypass or one-anastomosis gastric bypass. Occurrence after Roux-en-Y transit bipartition remains poorly documented. We report a 40-year-old male with severe obesity, prior endoscopic sleeve gastroplasty, who underwent a laparoscopic Roux-en-Y transit bipartition without intraoperative complications. On postoperative day (POD) 1, abdominal pain, tachycardia, and bilious vomiting developed. Computed tomography demonstrated proximal small bowel dilation with distal collapse and hyperdense intraluminal material. Re-exploration revealed blood clots at the ileo-ileal anastomosis causing proximal obstruction. Enterotomy, clot evacuation, additional anastomosis, peritoneal lavage, and intraoperative endoscopy were performed; no anastomotic leak was identified. Self-limited melena was managed with anticoagulation withholding and tranexamic acid. The patient was discharged on POD 5. Hemobezoar should be considered in early obstruction after Roux-en-Y-type bariatric anatomy; low threshold for re-exploration and endoscopy are essential.