Original article
Blood clot obstruction of the jejunojejunostomy after laparoscopic gastric bypass

https://doi.org/10.1016/j.soard.2011.12.014Get rights and content

Abstract

Background

Acute jejunojejunostomy (JJ) obstruction after laparoscopic gastric bypass secondary to the formation of an intraluminal blood clot is a rare event. We analyzed our experience with such complications from a large consecutive patient series at a university hospital that is a referral center for bariatric surgery.

Methods

A retrospective review of patient data in a register of all patients who had undergone gastric bypass from June 2004 to March 2011 was performed. Reoperations were analyzed for the cause and findings. The patients received routine postoperative administration of low-molecular-weight heparin.

Results

Of 1066 patients, 5 (.5%; 4 women and 1 man), who had undergone laparoscopic gastric bypass, with a median body mass index of 42 kg/m2 (range 40–46), underwent reoperation for obstruction of the JJ secondary to a blood clot. The indications for reoperation were signs of bleeding, nausea, or findings on abdominal computed tomography. The time of reoperation was 1, 1, 2, 3, and 11 days after the primary procedure. All patients underwent reoperation by laparoscopy, with evacuation of the blood clot through an opening of the suture or staple lines without additional revision of the JJ. The gastric remnant was decompressed using a percutaneously placed gastrostomy tube. One patient had gastric leakage from the staple lines (blowout) that necessitated several later revisions for subcutaneous abscesses. Another patient developed acute pancreatitis.

Conclusion

Blood clots can cause early obstruction of the JJ after gastric bypass. Awareness of this potentially rapidly progressive and life-threatening complication will allow immediate intervention and reduce the risk of serious sequelae.

Section snippets

Methods

From June 2004 to March 2011, 1066 patients underwent laparoscopic Roux-en-Y gastric bypass at Oslo University Hospital, Aker. Four surgeons performed all the procedures. The patients were identified from a prospective database of all patients who underwent bariatric surgery at the hospital. All reoperations were evaluated for the indication and findings. The Norwegian Data Protection Agency approved and licensed the patient register. The patients provided signed approval for the use of the

Results

Of 1066 patients, 5 (.5%) with early obstruction of the JJ from a blood clot were identified (Table 1). These 5 patients included 4 women and 1 man, with a median age of 37 years (range 32–51) and median body mass index of 42 kg/m2 (range 40–46; Table 1). Patient 1 had hyperlipidemia, patient 2 hypertension and epilepsy, and patient 5 had diabetes, hyperlipidemia, coronary artery disease, hypothyroidism, and chronic nephropathy. The remaining 2 patients had no somatic co-morbidity. Patient 5

Discussion

Postoperative intraluminal bleeding can cause severe complications after gastric bypass surgery. The incidence of gastrointestinal bleeding after gastric bypass has been reported in the range of .6%–3.7% [2], [4], [5], [6]. Such bleeding is usually self-limiting and often managed by a reduction of the low-molecular-weight heparin dosage, transfusions of fresh frozen plasma and blood, or endoscopic intervention at the gastrojejunostomy. Intraluminal bleeding can occur at the gastrojejunostomy or

Conclusion

Intraluminal blood clots can cause early obstruction at the distal anastomosis after gastric bypass. Laparoscopic evacuation of the coagulated blood without revision of the JJ and gastric remnant decompression has been our preferred treatment. Awareness of this potentially rapidly progressive and life-threatening complication can allow immediate intervention and might thus reduce the risk of serious sequelae.

Disclosures

The authors have received sponsored participation to international congresses of surgery by different companies not involved in the present study.

References (15)

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Cited by (13)

  • Surgical management of obstructing clot at the jejunojejunostomy after gastric bypass: a single center experience and literature review

    2021, Surgery for Obesity and Related Diseases
    Citation Excerpt :

    We were not able to associate the infections with preoperative co-morbidities such as diabetes or chronic proton pump inhibitor use. In a similar series of 5 patients, Mala et al. describe a protracted length of stay with morbidities of abdominal wall abscesses and fluid collections requiring IR drainage [14]. In his series he describes placing a G-tube in the remnant stomach of the patients but does not describe whether this was done before the clot was removed, the technique that we advise.

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