Retrograde intussusception causing small bowel obstruction in a 35 year old Female patient following a Roux en Y Bypass. Case report

Highlights • RI is a mysterious pathophysiology that is still uncommonly present post Roux en Y gastric bypass. • Exploratory laparoscopy is a more confirmative diagnostic option. • The state of the intussuscepted intestine determines the plan of treatment. • The most adequate surgical treatment technique is still debatable.
Introduction Intestinal intussusception is an uncommon entity when preceded by Roux en Y gastric bypass. Retrograde intussusception is an enigmatic phenomenon characterized by reversely intussuscepted intestinal loop that may involve any piece of the Roux en Y limbs. Computed Tomography is gold standard for diagnosis. Surgical management is highly debatable. Case presentation A 35 years old female known for morbid obesity, post roux en Y gastric bypass since 5 years with 100 % excess weight loss presenting for on-off episodes of small bowel obstruction symptoms. She was diagnosed laparoscopically for retrograde intussusception that was reduced easily with closure of Peterson’s pouch due to high suspicion of an internal hernia. She did well postoperatively and followed up adequately with no recurrence of her symptoms. Conclusion Retrograde intussusception remains an interesting uncommon phenomenon in the horizon of the roux en Y gastric bypass surgeries. Several surgical options were discussed in the last 12 years and they are still debatable.