A 49-year-old man presented with a 2-week history of gradual onset progressively worsening left upper quadrant pain. Ten months prior, he had a laparoscopic roux-en-Y gastric bypass (LRYGBP) for severe gastro-oesophageal reflux disease and obesity. On examination, his abdomen was not distended and was soft to palpation. The haemoglobin, white cell count, liver function test, lipase and lactate were normal. An abdominal CT scan demonstrated swirl sign. Given the suspicion of internal herniation, laparoscopy was performed demonstrating only partial closure of the jejuno-jejunal mesodefect resulting in herniation of the small bowel alimentary limb. Internal herniation should be considered as a differential diagnosis in all patients with previous LRYGBP and unexplained abdominal pain, nausea or vomiting. If closure of a mesodefect is to be attempted, a running, braided, non-absorbable suture should be used as a purse-string to avoid small defects with subsequent weight and mesenteric fat loss following bariatric surgery.
- gastro-oesophageal reflux
- small intestine
- obesity (nutrition)
- gastrointestinal surgery
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Contributors RP wrote the original draft of the manuscript. RP and MP performed the literature search. SD and TV provided the colour images and edited the manuscript. Figure 5 is an original electronic drawing created by TV. All authors reviewed, edited and approved the final version of the manuscript. All the listed authors agree with the content of the submitted case report for publication.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Disclaimer None of the authors have received any grants, equipment and/or pharmaceutical items requiring declaration. There are no potential conflicts of interest. The case report has not been published previously and is not under consideration elsewhere.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
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