title: Identification and management of an errant antiperistaltic Roux limb after total gastrectomy.
abstract: We recently evaluated two patients because of persistent, unexplained bilious vomiting following total gastrectomy with Roux-en-Y esophagojejunostomy. With the aid of intestinal manometry and reoperation, an antiperistaltic Roux limb was discovered in both cases. Isoperistaltic repositioning of the Roux limb led to resolution of both patients' symptoms. These case reports illustrate the devastating consequences of a poorly constructed Roux-en-Y esophagojejunostomy and demonstrate the utility of intestinal manometry in aiding the diagnosis of problems related to the Roux limb, particularly when surgical reexploration is not preferred or is inconclusive. By highlighting this avoidable technical error, we hope to prevent its future occurrence.
authors.affiliation: Intestinal Rehabilitation Program, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA. dibaise.john@mayo.edu
authors.forename: John K
authors.initials: JK
authors.lastname: DiBaise
authors.forename: Kishore
authors.initials: K
authors.lastname: Iyer
authors.forename: Jon S
authors.initials: JS
authors.lastname: Thompson
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects* / Q000379:methods; D001658:Biliary Fistula / Q000209:etiology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011127:Polyps / Q000175:diagnosis / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D012086:Reoperation; D018570:Risk Assessment; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000601:surgery; D016896:Treatment Outcome