AB226. SOH26AB_0356. Adult small bowel anterograde intussusception post-single anastomosis gastric bypass: leiomyoma as lead point—case report and literature review

Background: Small bowel intussusception is a well-recognised and potentially serious complication of laparoscopic Roux-en-Y gastric bypass surgery. Small bowel intussusception post-single anastomosis gastric bypass (SAGB) is considered to be far less likely given the absence of a jejuno-jejunal anastomosis with no disruption to the jejunal innervation. Here we present a rare case of anterograde small bowel intussusception 10 years post-SAGB requiring small bowel resection, with a benign leiomyoma acting as a lead point.

Case Description: A female in her 50s presented to our emergency department with sudden severe abdominal pain for 6 hours. Computed tomography (CT) imaging demonstrated a long segment of small bowel intussusception in the pelvis with marked mural thickening of the involved bowel. No lead point was identified. The patient underwent a laparotomy and small bowel resection. The histopathological analysis demonstrated a 3 cm leiomyoma as a lead point for a 12 cm anterograde intussusception with associated ischaemia-type injury.

Conclusions: In our literature review, there has been just one case reported of anterograde small bowel intussusception post-SABG to date, where similar to the case presented here, there was also a benign pathological lead point. Although less described, small bowel intussusception can also occur post-SAGB, and a high degree of suspicion is required to avoid potentially serious complications. In the case of postoperative SAGB intussusception where there is no jejuno-jejunostomy to act as a lead point, our view is that bowel resection should be considered due to the potential for a benign entity such as a lipoma/leiomyoma causing the intussusception.

Keywords: Gastric bypass; general surgery; intussusception; obesity; case report