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Internal herniation during pregnancy after banded Roux-en-Y gastric bypass: a unique location
  1. Daniëlle Susan Bonouvrie1,
  2. Evert-Jan Boerma2,
  3. Francois M H van Dielen1 and
  4. Wouter K G Leclercq1
  1. 1Obesity Centre Maxima, Maxima Medical Centre, Eindhoven/Veldhoven, Gelderland, The Netherlands
  2. 2Bariatric Surgery, Zuyderland Medical Centre, Heerlen, Limburg, The Netherlands
  1. Correspondence to Mrs Daniëlle Susan Bonouvrie; danielle.bonouvrie{at}


A 26-year-old multigravida, 30+3 weeks pregnant woman, was referred to our tertiary referral centre with acute abdominal pain and vomiting suspected for internal herniation. She had a history of a primary banded Roux-en-Y gastric bypass (B-RYGB). The MRI scan showed a clustered small bowel package with possible mesenteric swirl diagnosed as internal herniation. A diagnostic laparoscopy was converted to laparotomy showing an internal herniation of the alimentary limb through the silicone ring. The internal herniation was reduced by cutting the silicone ring. Postoperative recovery, remaining pregnancy and labour were uneventful. During pregnancy after B-RYGB, small bowel obstruction can in rare cases occur due to internal herniation through the silicone ring. Education regarding this complication should be provided before bariatric surgery. Treatment of women, 24 to 32 weeks pregnant, in a specialised centre for bariatric complications with a neonatal intensive care unit is advised to improve maternal and neonatal outcome.

  • obesity (nutrition)
  • pregnancy
  • gastroenterology

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  • Contributors DB, EB, FvD and WL all contributed to the conception, design, acquisition of data or analysis and interpretation of data. DB drafted the article and EB, FvD and WL critically revised the manuscript for important intellectual content. All authors gave final approval of the current version and agree to be accountable for the article and to ensure that all questions regarding the accuracy or integrity of the article are investigated and resolved.

  • 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.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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