Recurrent Epigastric Pain and Non-bilious Vomiting Caused by Internal Herniation and Obstruction of the Jejunal Loop Constructed by Roux-en-Y Anastomosis: A Case Report of Postoperative Pregnancy With Congenital Biliary Dilatation

TL;DR

A rare case of intestinal obstruction during pregnancy in a woman with a history of biliary surgery is reported, highlighting the importance of considering this complication in similar patients.

Contribution

This case report highlights a rare complication of Roux-en-Y surgery during pregnancy and emphasizes the need for timely diagnosis.

Findings

A 35-year-old pregnant woman with a history of Roux-en-Y surgery presented with epigastric pain and vomiting due to internal herniation.

The obstruction was caused by fibrous bands from the greater omentum and resolved after surgical resection.

Normal brown stool despite symptoms suggests the importance of considering Roux-en-Y limb obstruction in similar clinical scenarios.

Abstract

Congenital biliary dilatation (CBD) requires Roux-en-Y hepaticojejunostomy in childhood. We experienced a rare case of postoperative pregnancy of CBD with typical symptoms of ileus but with normal brown stool, due to the internal hernia and obstruction of the Roux-en-Y limb.

After a Roux-en-Y bypass surgery at the age of two, a 35-year-old woman had unrelenting epigastric pain and non-bilious vomiting for one week at 35 weeks’ gestation. During the cesarean section, internal herniation of the Roux-en-Y limb caused by fibrous bands extending from the greater omentum was revealed, which was resected to relieve the intestinal obstruction. The patient was discharged from the hospital on the sixth postoperative day.

When pregnant women with a history of Roux-en-Y reconstruction present with epigastric pain and recurrent non-bilious vomiting but with normal stool, intestinal obstruction of the Roux-en-Y limb should be considered to prevent adverse perinatal outcomes.

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