Roy Mayank, Fendrich Ivan, Li Jihui, Szomstein Samuel, Rosenthal Raul J
Section of Minimally Invasive Surgery, The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL 33331, USA.
Surg Laparosc Endosc Percutan Tech. 2012 Aug;22(4):e243-5. doi: 10.1097/SLE.0b013e31825d6c07.
Bezoar is a rare cause of small bowel obstruction after Roux-en-Y gastric bypass (RYGB). We report the case of a 34-year-old man who developed small bowel obstruction secondary to a phytobezoar at the jejunojejunal anastomosis, 5½ years after the patient underwent RYGB for morbid obesity. The phytobezoar developed in the background of recurring abdominal pain. Imaging studies suggested complete obstruction of the alimentary limb. Laparoscopic exploration demonstrated complete obstruction of the alimentary and biliopancreatic limb. Patient had successful treatment with laparoscopic enterototomy. Six months after the laparoscopic removal of phytobezoar, patient remained asymptomatic. Phytobezoar formation must be considered in the differential diagnosis when postgastric bypass patients present late with obstructive symptoms. We believe that this is the first report of a phytobezoar obstructing at the jejunojejunal anastomosis after RYGB.
胃石是Roux-en-Y胃旁路术（RYGB）后小肠梗阻的罕见原因。我们报告一例34岁男性病例，该患者在接受RYGB治疗病态肥胖5年半后，在空肠空肠吻合处发生植物性胃石继发小肠梗阻。植物性胃石在反复腹痛的背景下形成。影像学检查提示消化道支完全梗阻。腹腔镜探查显示消化道支和胆胰支完全梗阻。患者通过腹腔镜肠切开术获得成功治疗。腹腔镜切除植物性胃石6个月后，患者仍无症状。当胃旁路术后患者出现晚期梗阻症状时，鉴别诊断中必须考虑植物性胃石的形成。我们认为这是首例关于RYGB术后植物性胃石在空肠空肠吻合处梗阻的报告。
