This is a case of a 31-year-old Caucasian female that presented with a prior history of multiple bariatric surgeries including laparoscopic gastric band placement in 2006 that was converted to a laparoscopic sleeve gastrectomy in 2010 due to gastric reflux symptoms. We present the first reported case of a large bowel obstruction secondary to a Roux-en-Y gastric bypass including the surgical method used to correct this unusual complication of bariatric surgery. The relatively fixed nature and large caliber of the colon limits the risk of involvement with the mesenteric defects that typically trap and incarcerate the small bowel leading to obstruction. Large bowel obstruction, however, has not been reported in association with gastric bypass surgery. It is therefore a complication that requires a high index of suspicion and a low threshold for early intervention. This feared complication can have devastating consequences, such as long segment of small bowel ischemia, if not identified on time. Small bowel obstruction represents the predominant source of obstructions and is typically due to closed loop obstruction within internal hernias. An established complication of laparoscopic gastric bypass surgery is bowel obstructions with a reported incidence as high as 9.7%. Laparoscopic Roux-en-Y bypass (RYGB) is the approach of choice for bariatric surgical procedures, being performed in the majority of the 200,000 procedures performed in the United States in 2007. We present the interesting case of a patient with large bowel obstruction following laparoscopic Roux-en-Y gastric bypass surgery. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Tafadzwa P Makarawo, Colon and Rectal Surgeon, Colon and Rectal Center of Arizona, USA Colon and Rectal Surgeon, Swedish Colon and Rectal Clinic, 1101 Madison, Suite 510 Seattle, WA 98104, USA, Tel: 1-20, Fax: +1-20, E-mail: Ap| Accepted: Ap| Published: May 02, 2018Ĭitation: Makarawo TP, Bastawrous S, Bastawrous A (2018) Splenic Flexure Mobilization for Subacute Large Bowel Obstruction following Gastric Bypass: A Case Report. Tafadzwa P Makarawo 1,2, Sarah Bastawrous 3 and Amir Bastawrous 2ġColon and Rectal Surgeon, Colon and Rectal Center of Arizona, USAĢColon and Rectal Surgeon, Swedish Colon and Rectal Clinic, USAģDepartment of Radiology, University of Washington School of Medicine, Seattle, WA USA Department of Diagnostic Imaging, VA Puget Sound Health Care System, Seattle, WA USA Splenic Flexure Mobilization for Subacute Large Bowel Obstruction Following Gastric Bypass: A Case Report CONCLUSIONS Laparoscopic medial splenic flexure mobilization is a technically feasible and safe method.CASE REPORT | VOLUME 5, ISSUE 2 | OPEN ACCESS DOI: 10.23937/2378-3397/1410067 The mean time from ligation of the IMA to splenic flexure mobilization was 45 minutes. An anterior resection was done in 2 cases, a low anterior resection is 10 cases, and a coloanal anastomosis in 4 cases. The mean distal margin was 5.3 cm, and the mean number of harvested lymph nodes was 15. ![]() ![]() ![]() RESULTS The mean age was 60 years old, and the male- to-female sex ratio was 9:7. A medial-to-lateral mesocolon dissection was done, and the pancreas was dissected from the mesocolon of the transverse colon then, the greater omentum was dissected. The operation procedure is as follows: Under general anesthesia, the patient was placed in the Trendelenburg position, after making pneumoperitoneum, the inferior mesenteric artery (IMA) and the inferior mesenteric vein (IMV) were ligated and divided. METHODS This study retrospectively analyzed the medical records and operation videos of 16 patients who underwent laparoscopic splenic flexure mobilization in Our Lady of Mercy Hospital, The Catholic University of Korea by using a medial approach. Classical splenic flexure mobilization by means of the lesser sac opening is technically difficult in the laparoscopic era. PURPOSE: Splenic flexure mobilization in an anterior resection is a subject of controversy, but a tension-free anastomosis is needed in case of a low anterior resection or a coloanal anastomosis.
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