Small bowel obstruction caused by rare intraluminal hematoma secondary to gastric bypass: a case report

Year 2025, Volume: 16 Issue: 1, 1 - 3, 28.03.2025

Shamil Aliyev , Hakan Seyit , İlke Dolğun

https://doi.org/10.33706/jemcr.1447143

Abstract

Abstract
Introduction: With the increase in obesity and therefore obesity surgery in the world, there is also an increase in surgery-related complications. Mechanical small bowel obstruction after gastric bypass is a common complication and the most common causes of obstruction are kinking or stenosis of the entero-enterostomy, internal herniation, adhesions, external compression on the transverse mesocolon, incarceration of an abdominal wall hernia, or intussusception. One of these complications is intraluminal hematoma, which, although rare, has dangerous consequences that can even lead to mortality. Since it is a life-threatening complication, early diagnosis and emergency intervention are important.
Case report: In this case report, we wanted to emphasize the early effectiveness of radiology and surgery in the diagnosis and treatment processes of a patient with intraluminal hematoma after laparoscopic roux-NY gastric bypass.
Conclusion: . The most common location of intraluminal hematoma is the jejunojejunal anastomosis area. Symptoms may occur earlier (at the 12th postoperative hour). Whole-abdominal MDCT remains the main method of diagnosing intestinal obstruction, including small bowel obstruction resulting from intraluminal hematoma.

Keywords

gastric bypass, intraluminal hematoma, complication, emergency surgery, computed tomography

Ethical Statement

Informed consent was obtained from the patient for this case report.

Supporting Institution

none

References

• 1. Sunnapwar A, Sandrasegaran K, Menias CO, Lockhart M, Chintapalli KN, Prasad SR: Taxonomy and imaging spectrum of small bowel obstruction after Roux-en-Y gastric bypass surgery. AJR Am J Roentgenol 2010, 194(1):120-128.
• 2. Felsher J, Brodsky J, Brody F: Small bowel obstruction after laparoscopic Roux-en-Y gastric bypass. Surgery 2003, 134(3):501-505.
• 3. Green J, Ikuine T, Hacker S, Urrego H, Tuggle K: Acute small bowel obstruction due to a large intraluminal blood clot after laparoscopic Roux-en-Y gastric bypass. J Surg Case Rep 2016, 2016(8).
• 4. Husain S, Ahmed AR, Johnson J, Boss T, O'Malley W: Small-bowel obstruction after laparoscopic Roux-en-Y gastric bypass: etiology, diagnosis, and management. Arch Surg 2007, 142(10):988-993.
• 5.Uppot RN: Impact of obesity on radiology. Radiol Clin North Am 2007, 45(2):231-246.
• 6.Peeters G, Gys T, Lafullarde T: Small bowel obstruction after laparoscopic Roux-en-Y gastric bypass caused by an intraluminal blood clot. Obes Surg 2009, 19(4):521-523.
• 7. Mustafa RR, Khaitan L, Saleh AA, Elghalban H, Kedia A, Abbas M: Blood clot causing small bowel obstruction after Roux en-Y Gastric bypass: a Case Report & Review of Literature. Annals of Laparoscopic and Endoscopic Surgery 2019, 4.
• 8. Awais O, Raftopoulos I, Luketich JD, Courcoulas A: Acute, complete proximal small bowel obstruction after laparoscopic gastric bypass due to intraluminal blood clot formation. Surg Obes Relat Dis 2005, 1(4):418-422; discussion 422-413.
• 9. Shimizu H, Maia M, Kroh M, Schauer PR, Brethauer SA: Surgical management of early small bowel obstruction after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2013, 9(5):718-724.
• 10. Nelson LG, Gonzalez R, Haines K, Gallagher SF, Murr MM: Spectrum and treatment of small bowel obstruction after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2006, 2(3):377- 383, discussion 383.
• 11. Lewis CE, Jensen C, Tejirian T, Dutson E, Mehran A: Early jejunojejunostomy obstruction after laparoscopic gastric bypass: case series and treatment algorithm. Surg Obes Relat Dis 2009, 5(2):203-207.