Re-do Roux-en-Y gastric bypass in a patient with known midgut malrotation.

A 40-year-old woman presented with small bowel obstruction caused by an internal hernia through Peterson's defect. The patient was known to have midgut malrotation (MM) and also had laparoscopic Roux-en-Y gastric bypass for morbid obesity 6 years prior. An open revision of Roux-en-Y gastric bypass was performed as a result of ischemia of alimentary limb. She made a slow but uneventful recovery and was discharged home. MM is a rare congenital anomaly that requires the surgeon to be well aware of the unique variation in anatomy to perform a mirror image of the routine Roux-en-Y gastric bypass. At the end of this case report, we present a short literature review of published data related to MM encountered during Roux-en-Y gastric bypass.