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Laparoscopic management of an internal hernia in a pregnant woman with Roux-en-Y gastric bypass
  1. Umashankkar Kannan,
  2. Ranjan Gupta,
  3. Brian F Gilchrist,
  4. Venkata N Kella
  1. General Surgery, Bronx–Lebanon Hospital Center, Bronx, New York, USA
  1. Correspondence to Dr Umashankkar Kannan, ukannan{at}


Management of abdominal pain in a pregnant patient with a history of Roux-en-Y gastric bypass presents unique challenges. A misdiagnosis or delay in management can result in lethal maternal–fetal outcomes. We present a 30-year-old woman at 21 weeks of pregnancy presented with abdominal pain. She had a history of laparoscopic Roux-en-Y gastric bypass performed 3 years earlier. The clinical examination was remarkable for epigastric pain and tenderness. The vital signs and laboratory examinations were unremarkable. The CT scan was suggestive of an internal hernia. On an exploratory laparoscopy, the distal common small bowel was found to be herniating through the jejunojejunostomy mesenteric defect, causing intestinal obstruction with dilatation of the Roux limb and the biliopancreatic limb. The internal hernia was reduced, and no bowel resection was required. The mesenteric defect was closed with 3-0 silk sutures in a continuous fashion. The patient was discharged after 3 days and delivered a healthy baby at 40 weeks of gestation.

  • gastrointestinal surgery
  • general Surgery
  • pregnancy
  • obesity (nutrition)
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  • Contributors Concept, design of work, critical revision: UK, BFG, VNK. Drafting: UK, RG. Final approval: UK, RG, BFG, VNK.

  • 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 Obtained.

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

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