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Bypass enteritis or obstructive volvulus?

G B Sanders

    Archives of Surgery (Chicago, Ill. : 1960)
    |May 1, 1977
    PubMed
    Summary
    This summary is machine-generated.

    Two patients with jejunoileal shunts for morbid obesity developed bypass enteritis due to sigmoid anastomosis volvulus. Surgical correction by reimplanting the bowel into the transverse colon resolved the condition, suggesting mechanical obstruction as a key factor.

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    Area of Science:

    • Gastroenterology
    • Bariatric Surgery
    • Surgical Complications

    Background:

    • Jejunoileal shunts were a surgical treatment for morbid obesity.
    • Bypass enteritis is a known complication of these procedures.
    • This study examines a specific variation in shunt anatomy and its consequences.

    Observation:

    • Two patients undergoing Scott-type jejunoileal shunt surgery had their bypassed bowel anastomosed end-to-side into the midsigmoid colon.
    • Both patients subsequently developed symptoms consistent with bypass enteritis.
    • Volvulus at the sigmoid anastomosis was identified as the cause in both cases.

    Findings:

    • Surgical revision, involving take-down of the sigmoid anastomosis and reimplantation into the transverse colon, successfully treated the bypass enteritis in both patients.

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  • Antibiotic treatment was not required for resolution.
  • The findings suggest that mechanical obstruction at the anastomosis is a primary factor in the development of bypass enteritis.

    • Implications:

    • This suggests that careful consideration of anastomosis placement in jejunoileal shunts is crucial to avoid mechanical complications.
    • Reimplantation into the transverse colon may be a preferred surgical strategy to prevent bypass enteritis.
    • Further research into the mechanical aspects of intestinal anastomosis in bariatric surgery is warranted.