Intussusception in a pregnant woman

Abstract

Abdominal pain in a pregnant woman with a history of laparoscopic Roux-en-Y gastric bypass (LRYGB) in the emergency department is challenging. Intussusception is a rare cause of small bowel obstruction after LRYGB and can lead to intestinal necrosis, perforation, sepsis and death. The authors report a case of a 34-week pregnant patient, previously submitted to LRYGB, presenting to the emergency department with abdominal pain and vomiting. A computed tomography scan suggested the presence of ileoileal intussusception. So, an emergent laparotomy was performed with invagination reduction. The postoperative period was uneventful, as well as pregnancy and caesarian performed 4 weeks after surgery. At the 45-month follow-up, there was no recurrence of intussusception.

Figure 1

Axial view of the CT scan showing jejunojejunal intussusception with fat and blood vessels within the lumen of intestine (white arrow—typical “target sign”).

Figure 2

Coronal view of the CT scan showing intussusception (white arrow—sausage-shaped thickened bowel Wall).

Figure 3

Retrograde intussusception of the common limb into the jejunojejunostomy.

Figure 4

Intussusception reduction.

Figure 5

Intussusception reduction.

Figure 6

Recovery from initial ischemia.