Reconstruction of short bowel syndrome after internal hernia in a pregnant woman with previous bariatric surgery.
BACKGROUND
Bariatric surgery is most often performed with the laparoscopic Roux-en-Y gastric bypass. A complication to the laparoscopic Roux-en-Y gastric bypass is internal hernia, which occurs in up to 16% of the patients. Since the laparoscopic Roux-en-Y gastric bypass is performed in women of fertile age, internal hernia may occur during pregnancy.


METHODS
A 22-year old woman with a history of laparoscopic Roux-en-Y gastric bypass suffered from massive internal hernia during pregnancy with widespread bowel necrosis. Extensive surgery was performed leaving the patient with an intact duodenum, 15cm of jejunum, 35cm of ileum and colon. Parenteral nutrition was initiated and ten months after the internal hernia, intestinal continuity was re-established. Ten weeks later the patient reached parenteral nutrition independence.


CONCLUSIONS
Internal hernia after laparoscopic Roux-en-Y gastric bypass can be difficult to diagnose, especially during pregnancy and might be severe and life threatening for both mother and child.


CONCLUSIONS
Obstetricians and abdominal surgeons must be aware of this condition. Surgery should be performed on a wide indication. When bowel necrosis is found it should be resected and in case of extensive bowel resection the patient should be evaluated in centres specialized in intestinal failure.
Centre for Nutrition and Bowel Disease, Department of Gastroenterology, Aalborg University Hospital, Hobrovej, DK-9100 Aalborg, Denmark. Electronic address: marta.borghede@gmail.com.
Märta Kristina
MK
Borghede
Lars
L
Vinter-Jensen
Jens Christian
JC
Andersen
Peter Brøndum
PB
Mortensen
Henrik Højgaard
HH
Rasmussen
Internal hernia; Laparoscopic gastric bypass; Pregnancy; Short bowel syndrome