背景:有胃旁路手术史的患者腹痛的来源很难确定。同步疾病过程可能最终是其症状的原因。在该人群中,呕血和阻塞的病因包括边缘溃疡和内部疝的诊断。考虑到减肥手术的潜在并发症,在这些患者的检查期间,保持广泛的鉴别诊断是很重要的.
方法:一名女性,有腹腔镜Roux-en-Y胃旁路术(RYGB)病史,表现为腹痛和呕血。术中发现空肠空肠造口术肠套叠导致梗阻和缺血性肠。此外,发现存在Roux肢体的边缘溃疡穿孔。这个病人做了食管胃十二指肠镜检查,肠切除术,空肠空肠吻合术,和格雷厄姆补丁修复。
结论:本病例重点介绍了一例有RYGB病史的患者,表现为梗阻和消化道出血。尽管最初被诊断为内疝和Mallory-Weiss呕血,手术探查显示并发肠套叠和边缘溃疡。虽然肠套叠是减肥手术的罕见并发症,它可以继发于肠系膜变薄和运动功能障碍的显着体重减轻。必须对包括粘连性疾病在内的梗阻和消化道出血的原因进行广泛的鉴别诊断。腹壁疝,内疝,肠套叠,和边缘溃疡。
结论:减重手术后梗阻或消化道出血的发现可能是手术急症。虽然这些症状可能归因于单一诊断,临床医生必须在患者检查期间考虑同步病理的存在.
BACKGROUND: The source of abdominal pain in patients with a history of gastric bypass can be difficult to determine. Synchronous disease processes may ultimately be the cause of their symptoms. Among the etiologies for hematemesis and obstruction in this population are the diagnoses of marginal ulcer and internal hernia. Given the potential complications of bariatric surgery, it is important to maintain a broad differential diagnosis during the workup of these patients.
METHODS: A female with history of laparoscopic Roux-en-Y gastric bypass (RYGB) presented with abdominal pain and hematemesis. Intraoperative findings revealed intussusception of the jejunojejunostomy resulting in obstruction and ischemic bowel. Additionally, a perforated marginal ulcer of the Roux-limb was found to be present. This patient underwent esophagogastroduodenoscopy, bowel resection, jejunojejunostomy revision, and Graham patch repair.
CONCLUSIONS: This
case highlights a patient with history of RYGB presenting with obstruction and gastrointestinal bleeding. Although initially diagnosed with internal hernia and Mallory-Weiss hematemesis, surgical exploration revealed concurrent intussusception and marginal ulceration. While intussusception is a rare complication of bariatric surgery, it can occur secondary to mesenteric thinning and motility dysfunction from significant weight loss. It is imperative to maintain a broad differential diagnosis for the causes of obstruction and GI bleeding that include adhesive disease, abdominal wall hernia, internal hernia, intussusception, and marginal ulcers.
CONCLUSIONS: Findings of obstruction or GI bleeding after bariatric surgery may represent a surgical emergency. While these symptoms may be attributed to a single diagnosis, clinicians must consider the presence of synchronous pathologies during the workup of patients.