Massachusetts Chapter of the American College of Surgeons

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Obstructing Clots at Jejunojejunal Anastomosis Following Roux-en-Y Gastric Bypass
Hassan Beesley1, Donald Hess2
1Boston University School of Medicine, Boston, MA 2Boston Medical Center, Boston, MA

Background: Roux-en-Y gastric bypass is a proven treatment for morbid obesity and its sequelae. Gastric bypass has a safe risk profile, but post-operative complications can be seen. We report 10 cases of post-operative bleeding causing an obstructing clot at the jejunojejunostomy (JJ).
Methods: The local MBSAQIP database was queried for gastric bypass patients undergoing re-operation for small bowel obstruction. All patients who were found to have an obstructing clot at the JJ between June, 2010 and December, 2019 were selected for chart review.
Results: The most common presenting symptoms were Hematocrit drop (9/10), nausea (9/10), abdominal pain (7/10), and hematemesis (4/10). There were 12 total re-operations performed across the 10 patients, 11 of these were performed laparoscopically. The most frequent morbidity was a post-operative abscess (4/10). Operative notes from these cases describe gross spillage into the peritoneal cavity. In later cases, the remnant stomach was decompressed at the start of re-operation, reducing spillage.
Conclusion: Despite the low rate of obstructing clots at the JJ, there is a risk for serious complications. Presenting symptoms include nausea and abdominal pain, which help differentiate it from other causes of decreased hematocrit. Diagnosis is commonly made with CT scan. Decompression of a dilated remnant stomach before addressing the clot can prevent intraperitoneal spillage and abscess formation. Enterotomy creation and removal of clot is recommended, without fear of continued bleeding.


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