with Dr. A. Sofia Espinoza, Dr. Ana María Otero
We present a case of intestinal occlusion that was found in a patient after obesity surgery.
A 57-year-old female patient, with no known drug allergies, with a previous history of HBP and Gastric bypass in 2008 due to Morbid obesity (BMI 46 > BMI 28). The patient came to the emergency room due to a 3-day abdominal pain that had increased in intensity, with no vomiting or other symptoms.
A Blood test and an abdominal X-ray were performed, finding a mild leukocytosis. Due to the persistence of pain, it was decided to request an abdominal CT-Scan, which found signs of intestinal obstruction, but was unable to identify the cause. It was decided to perform an exploratory laparoscopy.
The patient was placed in the supine position with open legs. The surgeon stood between he legs. A total of 3 trocars were used. A 12mm trocar was placed in a supra umbilical position for a 30° scope. A 5 mm trocar was placed at the right flank and another 5mm trocar was placed at the left flank, serving as working channels for the leading surgeon.
After examining the entire abdomen, an adhesion in the liver which caused an occlusion at the level of the jejunal-jejunal anastomosis was objectivie. We proceeded to section the adhesion using the Ligasure. We then checked that the alimentary limb and the jejuno-jejunostomy were correct and looked good. The next step was to check that the rest of the bowel looked good, with no signs of intestinal occlusion, ischemia, or other injuries. We reached the ligament of Treitz ending the review. We finally checked that the Petersen defect and the mesenteric defect of the jejuno-jejunostomy were closed.
The surgery took 25 minutes. The postoperative course was correct.
The patient started oral intake 24 hours after the surgery and left hospital on the 2nd postoperative day.
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