Obstruction of defunctionalized small bowel: its occurrence after bypass surgery for morbid obesity

Complications associated with jejunoileal bypass for morbid obesity are being recognized more frequently. A variety of mechanical obstructions in the defunctionalized small-bowel segment have recently been corrected in seven surgical patients. Volvulus of the defunctional limb was the most frequent cause of obstruction. Intussusception, bypass enteritis, fascial hernia, and adhesive bands were also causes of obstruction. Radiographic contrast studies were valuable in establishing the preoperative diagnosis. The altered small-intestinal anatomy predisposed these patients to a uniquely subtle and dangerous form of closed-loop obstruction. Prompt recognition was based on patient history and physical findings. Characteristic roentgenographic findings often confirmed the diagnosis. Clinical suspicision of these small-bowel obstructive syndromes may lead to early surgical treatment.