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. 2024 Jul 4;10(3):e31-e35.
doi: 10.1055/s-0044-1788065. eCollection 2024 Jul.

Internal Hernia Post-Single Anastomosis Gastric Bypass: Case Series with Review of Literature

Abdulmenem Abualsel  1 , Raja Nadeem  1 , Fatema Abdulkarim Al-Ahmed  1 , Ebrahim Adel Almahmeed  1 , Roshan George Varkey  1 , Sameer Almobarak  1 , Ajaz A Wani  1
Affiliations

Internal Hernia Post-Single Anastomosis Gastric Bypass: Case Series with Review of Literature

Abdulmenem Abualsel et al. Surg J (N Y). .

Abstract

Obesity is an emerging worldwide health care issue. It has a direct and indirect bearing on health-related outcomes. Rates of overweight and obesity have grown manifold in the past few decades globally. Once considered a problem of the affluent societies only, obesity is now dramatically on the rise in low- and middle-income countries also. Single anastomosis gastric bypass (SAGB) is one of the combined bariatric procedures adopted for weight loss in patients failing maximal medical therapy. Internal hernia (IH) after SAGB is a less recognized clinical entity. We hereby report our experience with four such cases under light of current available literature. Bariatric procedures are associated with some short- and long-term limitations. IHs are among one of the dreaded complications associated with some bariatric procedures with rates reaching up to 16% after classic Roux-en-Y gastric bypass. The incidence of IH post-SAGB is comparatively rare and is very less frequently reported. Symptoms of IH post-SAGB are quite nonspecific and depend on the time and extent of herniation. The symptoms can vary from benign intermittent colicky pain to severe intra-abdominal pain presenting as a surgical emergency. Routine physical examination and biochemical investigations are nonspecific and unreliable in evaluating those patients. Computed tomography (CT) with intravenous and oral contrast is the most common imaging modality used for preoperative evaluation of those symptoms. The CT findings can be unremarkable in patients having intermittent symptoms/herniation. Diagnostic laparoscopy is the cornerstone for diagnosis and management of patients having high suspicion of IH.

Keywords: Roux-en-Y gastric bypass; contrast-enhanced computerized tomography; excess weight loss; internal hernia; single anastomosis gastric bypass.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Intraoperative picture of an internal hernia through the Petersen's defect (case 1).
Fig. 2
Fig. 2
Intraoperative picture demonstrating reduction of internal hernial contents (case 1).
Fig. 3
Fig. 3
Computed tomography (CT) picture demonstrating swirling of mesentery and distended excluded stomach (case 1).
Fig. 4
Fig. 4
Internal hernia with small bowel as content through the Petersen's defect (case 3).
Fig. 5
Fig. 5
After reduction of contents (case 3).
Fig. 6
Fig. 6
Computed tomography (CT) demonstrating distended excluded stomach (case 3).
See this image and copyright information in PMC

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