title: Small-bowel volvulus in late pregnancy due to internal hernia after laparoscopic Roux-en-Y gastric bypass.
abstract: Internal hernias are a specific cause of acute abdominal pain and are a well-known complication after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Although internal hernias are a rare cause of intestinal obstruction, they may evolve towards serious complications, such as extensive bowel ischemia and gangrene, with the need for bowel resection and sometimes for a challenging reconstruction of intestinal continuity. The antecolic position of the Roux limb is associated with a decrease in the incidence of small-bowel obstruction and internal hernias. The best prevention of the formation of these hernias is probably by closure of potential mesenteric defects at the initial operation with a non-absorbable running suture. We present a patient in late pregnancy with a small-bowel volvulus following laparoscopic Roux-en-Y gastric bypass for morbid obesity and discuss the available literature. For a favorable obstetric and neonatal outcome, it is crucial not to delay surgical exploration and an emergency operation usually is mandatory.
authors.affiliation: Department of Surgery, Spital STS AG Thun, Thun, Switzerland. markus.naef@spitalstsag.ch
authors.forename: Markus
authors.initials: M
authors.lastname: Naef
authors.forename: Wolfgang G
authors.initials: WG
authors.lastname: Mouton
authors.forename: Hans E
authors.initials: HE
authors.lastname: Wagner
mesh_terms: D000328:Adult; D005260:Female; D015390:Gastric Bypass; D046449:Hernia, Abdominal / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D045822:Intestinal Volvulus / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D010535:Laparoscopy; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000601:surgery; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000601:surgery; D016896:Treatment Outcome