Internal herniation during pregnancy after banded Roux-en-Y gastric bypass: a unique location.
Daniëlle Susan BonouvrieEvert-Jan BoermaFrancois M H van DielenWouter K G LeclercqPublished in: BMJ case reports (2020)
A 26-year-old multigravida, 30+3 weeks pregnant woman, was referred to our tertiary referral centre with acute abdominal pain and vomiting suspected for internal herniation. She had a history of a primary banded Roux-en-Y gastric bypass (B-RYGB). The MRI scan showed a clustered small bowel package with possible mesenteric swirl diagnosed as internal herniation. A diagnostic laparoscopy was converted to laparotomy showing an internal herniation of the alimentary limb through the silicone ring. The internal herniation was reduced by cutting the silicone ring. Postoperative recovery, remaining pregnancy and labour were uneventful. During pregnancy after B-RYGB, small bowel obstruction can in rare cases occur due to internal herniation through the silicone ring. Education regarding this complication should be provided before bariatric surgery. Treatment of women, 24 to 32 weeks pregnant, in a specialised centre for bariatric complications with a neonatal intensive care unit is advised to improve maternal and neonatal outcome.
Keyphrases
- roux en y gastric bypass
- weight loss
- bariatric surgery
- obese patients
- small bowel
- gastric bypass
- abdominal pain
- pregnant women
- primary care
- pregnancy outcomes
- computed tomography
- risk factors
- physical activity
- type diabetes
- polycystic ovary syndrome
- preterm infants
- minimally invasive
- metabolic syndrome
- gestational age
- hepatitis b virus
- insulin resistance
- respiratory failure
- robot assisted
- pulmonary embolism
- birth weight