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Video case report| Volume 5, ISSUE 1, P111-115, January 2009

Laparoscopic reduction of small bowel intussusception in a 33-week pregnant gastric bypass patient: surgical technique and review of literature

Published:September 19, 2008DOI:https://doi.org/10.1016/j.soard.2008.09.008
      Intussusception is a rare etiology of bowel obstruction in adults and accounts for 1–3% of those cases. It is associated with an underlying mass such as a tumor or polyp in >80% of patients [
      • Penney D.
      • Ganapathy R.
      • Jonas-Obichere M.
      • El-Refeay H.
      Intussusception: a rare cause of abdominal pain in pregnancy.
      ,
      • Azar T.
      • Berger D.L.
      Adult intussusception.
      ,
      • Begos D.G.
      • Sander A.
      • Modlin I.M.
      The diagnosis and management of adult intussusception.
      ,
      • Aston S.J.
      • Machlfeder H.I.
      Intussusception in the adult.
      ]. In gastric bypass patients, intussusception is an uncommon complication [
      • Edwards M.A.
      • Grinbaum R.
      • Ellsmere J.
      • Jones D.B.
      • Schneider B.E.
      Intussusception after Roux-en-Y gastric bypass for morbid obesity: case report and literature review of rare complication.
      ,
      • Gerst P.H.
      • Iyer S.
      • Murthy R.M.
      • Albu E.
      Retrograde intussusception as a complication of Roux-en-Y anastomosis.
      ]. The common channel distal to the jejunojejunostomy is the usual site of intussusceptions. The direction of intussusception can be either antegrade or retrograde, but most reported cases are retrograde in nature. The probable etiology can include the presence of an ectopic pacemaker causing retrograde peristalsis. Alternatively, it is believed that dysmotility disorder can occur after Roux-en-Y gastric bypass owing to disruption of the pacesetter. Intussusception has also been reported to complicate pregnancy [
      • Connolly M.M.
      • Unti J.A.
      • Nora P.F.
      Bowel obstruction in pregnancy.
      ,
      • Moore D.T.
      • Watts C.D.
      • Wilbanks G.D.
      Intussusception complicating pregnancy: report of a case.
      ,
      • Shenhav S.
      • Gemer O.
      • Segal S.
      • Linova L.
      • Joffe B.
      Preoperative diagnosis of intestinal intussusception in pregnancy: a case report.
      ,
      • Perdue P.W.
      • Johnson Jr, H.W.
      • Stafford P.W.
      Intestinal obstruction complicating pregnancy.
      ]. Although it is a rare occurrence, intussusception can have devastating consequences if not promptly diagnosed and managed. The difficulty of reaching the diagnosis in pregnant patients, as well as the challenges of surgical management of a pregnant abdomen, increases the seriousness of such presentation.

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