title: Intussusception after Roux-en-Y gastric bypass.
abstract: BACKGROUND
  Jejuno-jejunal (J-J) intussusception is a rare complication after Roux-en-Y gastric bypass (RYGB). Prompt diagnosis is critical as it may lead to obstruction and bowel necrosis, but clinical presentation is nonspecific. A definitive treatment plan has not been established with intussusception after RYGB. The aim of our study was to describe clinical presentation and outcomes of treatment in patients with intussusception after RYGB.
  
  
  METHODS
  Out of 3022 patients who underwent laparoscopic RYGB between January 2003 and January 2013, 12 (0.4%) patients presented with intussusception after RYGB. A retrospective review of a prospectively collected database was performed.
  
  
  RESULTS
  Of the 12 patients, 11 (91.7%) presented with left or right upper quadrant abdominal pain as their chief complaint, and 1 (8.3%) presented with persistent nausea and vomiting. Diagnosis was made by computed tomographic scan (n = 1) or intraoperative findings (n = 11) at a mean period of 24.9 ± 26.0 months (range 3-85) after laparoscopic RYGB. Seven (58.3%) patients were treated only with reduction, 2 (16.7%) with resection and revision of J-J anastomosis, the remaining 3 (25.0%) underwent imbrication/plication of the J-J anastomosis. Only 1 (8.3%) patient, who was treated by reduction, returned with subsequent finding of recurrent intussusception at 9 months. All patients did well at a mean follow-up of 12.7 ± 16.4 months (range 1-47).
  
  
  CONCLUSIONS
  While reduction alone of the intussusception is safe and effective, there is a risk of recurrence, and imbrication of the J-J anastomosis may be a more effective means of treatment.
authors.affiliation: Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health, Orlando, Florida.
authors.forename: Derek
authors.initials: D
authors.lastname: Stephenson
authors.affiliation: Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health, Orlando, Florida.
authors.forename: Rena C
authors.initials: RC
authors.lastname: Moon
authors.affiliation: Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health, Orlando, Florida.
authors.forename: Andre F
authors.initials: AF
authors.lastname: Teixeira
authors.affiliation: Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health, Orlando, Florida. Electronic address: muhammad.jawad@orlandohealth.com.
authors.forename: Muhammad A
authors.initials: MA
authors.lastname: Jawad
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D007443:Intussusception / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D007579:Jejunal Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000473:pathology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Complications; Gastric bypass; Imbrication; Intussusception; Reduction; Revision