Imaging of Small Bowel Obstruction following Gastric Bypass Surgery for Morbid Obesity A retrospective review
Journal Title: Sultan Qaboos University Medical Journal - Year 2010, Vol 10, Issue 3
Abstract
Tis study is a single institution retrospective evaluation of imaging fndings of small bowel obstruction (SBO) after retrocolic antegastric Roux-en-Y gastric bypass surgery for morbid obesity. Methods: Te radiological database of 490 patients who underwent gastric bypass surgery for morbid obesity from January 2001- 2005 at the Royal Victoria Hospital McGill University Health Center was searched for SBO complications related to the procedure. Tere were 22 cases of small bowel obstruction related to the procedure. Ten patients had abdominal and pelvic computed tomography (CT) scans, 12 patients had upper gastrointestinal (UGI) and small bowel follow through (SBFT). Results: Among 22 cases of SBO, 14 cases were due to anastomotic stenosis or adhesion, 7 due to internal hernia and one to jejuno-jejunal intussusception. Among the 14 patients with SBO related to adhesion and anastomotic narrowing, 11 patients were managed medically and 3 cases managed surgically. CT scans correctly diagnosed 4 out of 5 cases including the 3 patients managed surgically and UGI and SBFT examinations diagnosed the remaining 9 cases that were managed medically. Among the 7 patients with internal hernias, CT scans correctly diagnosed 2 out of 4 cases, while UGI and SBFT examinations correctly diagnosed 1 out of 3. Te jejuno-jejunal intussusception was correctly diagnosed by CT scan. Conclusion: Te most frequent cause of SBO is anastomotic narrowing or adhesion. CT scan remains the most appropriate imaging modality in diagnosing acute presentation of SBO caused by internal hernia or adhesion/anastomotic narrowing. UGI and SBFT appear more appropriate for diagnosing the subacute insidious presentation of adhesive partial SBO.
Authors and Affiliations
Rashid Al-Sukaiti| Department of Radiology and Molecular Imaging, Sultan Qaboos University Hospital, Muscat, Oman, Lawrence Stein| Royal Victoria Hospital, Department of Diagnostic Radiology and Surgery, McGill University Health Center, Montreal, Canada, Nicholas Christou| Royal Victoria Hospital, Department of Diagnostic Radiology and Surgery, McGill University Health Center, Montreal, Canada, Benoit Mesurolle| Royal Victoria Hospital, Department of Diagnostic Radiology and Surgery, McGill University Health Center, Montreal, Canada, Giovanni P Artho| Royal Victoria Hospital, Department of Diagnostic Radiology and Surgery, McGill University Health Center, Montreal, Canada
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