Concurrent internal hernia and intussusception after Roux-en-Y gastric bypass

Description 

A 32-year-old woman with medical history significant for open Roux-en-Y gastric bypass performed 11 years prior presented to an urgent care with sudden severe epigastric pain associated with nausea and vomiting. She was profoundly hypothermic (91°F) and bradycardic (40 bpm) but maintained normal blood pressure. Laboratory values were grossly within normal limits except for an elevated lactic acid (2.99 mmol/L). Rewarming protocol, broad-spectrum intravenous antibiotics (piperacillin–tazobactam and vancomycin) and intravenous fluid resuscitation were initiated at this time. CT of the abdomen with intravenous and oral contrast demonstrated intussusception at the site of the jejunojejunal anastomosis with severe oedema of the mesentery and focally dilated bowel consistent with a high-grade obstruction due to an internal hernia (figure 1A). The patient was emergently transferred to the hospital and underwent an exploratory laparotomy. Intraoperatively, the intussuscepted segment of small bowel surrounding the jejunojejunal anastomosis was identified with an associated...

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