Gastric bypass: jejunal obstruction and stenosis
Epublication WebSurg.com, Feb 2012;12(02). URL: http://websurg.com/doi/lt03enherron001
Small bowel obstruction at or near the jejuno-jejunal anastomosis is a rare complication after gastric bypass, occurring in less than 1% of patients. Obstruction at the distal anastomosis is different from stricture at the proximal anastomosis, in that it is not caused by hypertrophic scarring. Rather, obstruction occurs due to either abnormal folding (kinking) of the anastomosis or narrowing of the anastomosis at the site of the enterotomy closure due to technical error. Since the distal anastomosis includes both the alimentary and the biliopancreatic limbs of the bypass, obstruction at this location may present with very different symptoms. Obstruction of the alimentary limb will result in nausea and vomiting, while obstruction of the biliopancreatic limb results in gastric remnant dilatation. Diagnosis is best accomplished with CT imaging, as plain X-rays will not show a dilated gastric remnant or biliopancreatic limb. Treatment of obstruction at the jejunojejunostomy often requires surgical intervention, although blockage due to edema may resolve with conservative management, sometimes requiring percutaneous decompression of the excluded stomach. It should also be remembered that bariatric patients may also suffer from obstruction caused by adhesions and may require lysis of such adhesions like any general surgical patient.