Bypass enteritis or obstructive volvulus?

In a consecutive series of 40 Scott-type jejunoileal shunts for morbid obesity, only two patients had the bypassed bowel drained end-to-side into the midsigmoid colon. In both of these patients, typical "bypass enteritis" as described by Passaro developed, but they were found to have volvulus at the sigmoid anastomosis. Both were cured by take-down of the anastomosis and reimplantation of the bypassed bowel into the transverse colon. No antibiotic treatment was found necessary. We suspect that obstruction of a mechanical nature plays a basic role in most, if not all, cases of "bypassed enteritis."