Omental infarction: a cause of acute abdominal pain after antecolic gastric bypass.
BACKGROUND
The antecolic approach to the laparoscopic Roux-en-Y gastric bypass (LGB) has been demonstrated to decrease the incidence of internal herniation. However, specific complications of this approach have not been documented. We describe the clinical presentation related to complications of this technique.


METHODS
The outcomes of 201 consecutive patients who had undergone antecolic LGB by a single surgeon during a 24-month period were retrospectively evaluated for complications.


RESULTS
Of the 201 LGB patients, 3 (1.5%) developed complications attributable to omental division. All 3 had an identical presentation of acute, localized abdominal pain without significant signs of systemic illness. All 3 patients developed acute symptoms on postoperative day 3. Laparoscopic reexploration on postoperative day 3, 4, and 4 demonstrated partial omental infarction without other pathologic findings. All patients had immediate relief of symptoms and had no further complications.


CONCLUSIONS
Partial omental infarction is a complication of omental transection while performing the antecolic approach to the LGB. Omental infarction should be part of the differential diagnosis, including anastomotic leak, in patients who develop abdominal pain 3-4 days after LGB.
Dallal
Ramsey M
RM
Albert Einstein Healthcare Network, Philadelphia, PA. USA. dallalr@einstein.edu
Bailey
Linda A
LA
D015746:Abdominal Pain / Q000209:etiology* / Q000601:surgery; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007238:Infarction / Q000150:complications* / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D009852:Omentum / Q000098:blood supply*; D012086:Reoperation; D012189:Retrospective Studies