# Roux en Y gastric bypass and iterative intussusception at the jejuno-jejunal anastomosis: Conversion into one anastomosis gastric bypass (with video) - A case report

## TL;DR

This case report describes a rare complication after gastric bypass surgery and a new treatment approach involving conversion to a different surgical technique.

## Contribution

Presents a novel treatment for recurrent jejuno-jejunal intussusception by converting RYGB to OAGB.

## Key findings

- Chronic intussusception at the jejuno-jejunal anastomosis is a rare complication after RYGB.
- Conversion to one anastomosis gastric bypass resolved symptoms and prevented recurrence in this patient.
- CT scans and patient symptoms are key for diagnosing this complication.

## Abstract

The aim of this article is to describe a rare complication of Roux en Y gastric bypass (RYGB): recurrent intestinal intussusception of the biliary limb, and an original treatment: the removal of the jejuno-jejunal anastomosis with conversion into “short limb” one anastomosis gastric bypass (OAGB).

A 25-year-old patient underwent RYGB fashioned with a 50 cm-length biliary loop and a 150 cm-length alimentary loop. She was hospitalized other 3 times in the following months for episodes of acute abdominal pain and excessive weight loss, with CT scans showing intussusception at the jejuno-jejunal anastomosis. Conversion from RYGB to OAGB with “short biliary limb” was performed. The patient at 60-month follow-up has no bile reflux and regained weight.

Small bowel intussusception is a rare complication that can occur following Roux-en-Y gastric bypass (RYGB) surgery, leading to symptoms like acute or chronic abdominal pain. Treatment options reported in medical literature include resection and re-fashioning of the jejuno-jejunal anastomosis, simple reduction (with a risk of recurrence), and imbrication/plication of the jejuno-jejunal anastomosis. Given the rarity of this complication, there are no standardized recommendations, and the best treatment should be determined on a case-by-case basis, taking into consideration the patient's unique circumstances and the medical team's expertise.

Intestinal intussusception at the jejuno-jejunal anastomosis responsible for chronic abdominal pain is a rare complication after RYGB. One of the possible treatments is conversion into OAGB.

•Chronic intussusception at the jejuno-jejunal anastomosis is a rare complication after RYGB•The diagnosis is based on patients' symptoms and CT scan findings•Conversion from RYGB to OAGB is a possible effective treatment

Chronic intussusception at the jejuno-jejunal anastomosis is a rare complication after RYGB

The diagnosis is based on patients' symptoms and CT scan findings

Conversion from RYGB to OAGB is a possible effective treatment