Altieri Maria S, Telem Dana A, Kim Pamela, Gracia Gerald, Pryor Aurora D
Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center. Stony Brook, New York.
Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center. Stony Brook, New York.
Surg Obes Relat Dis. 2015 May-Jun;11(3):667-71. doi: 10.1016/j.soard.2014.09.025. Epub 2014 Oct 6.
There is an increasing trend toward morbid obesity in women of childbearing age and a subsequent increase in number of weight reduction surgeries in these individuals. As a result, special attention needs to be paid to potential postsurgical complications during pregnancy, particularly after Roux-en-Y gastric bypass (RYGB). We are presenting our small case series and our suggestions for management for the pregnant bariatric patient. The aim of this study is to review our institutional experience and present our algorithm to approach pregnant women presenting with abdominal pain and/or emesis after RYGB.
After Institutional Review Board approval, a retrospective chart review was performed at a single center institution between 2010 and 2013. Data regarding clinical presentation, physical exam findings, laboratory values, radiographic studies, intraoperative findings, and clinical outcomes of both mother and fetus were collected and reviewed for pregnant patients with history of RYGB and abdominal distress.
Five patients were identified. Patient age ranged from 22-34 years (mean 28.4). Gestational age ranged from 9-31 months (mean 19.2). Average body mass index at presentation was 30.3 kg/m(2). Of the 5 patients, 4 presented with abdominal pain and one with intractable emesis. Four patients were taken to the operating room. One was successfully discharged. Two of the patients had an obstruction from adhesions, and the other 2 were found to have internal hernia. There was no mortality for either fetus or mother. One patient required premature delivery at 28 weeks.
Pregnant women with history of RYGB who present with abdominal pain should be evaluated urgently for internal hernia or obstruction. A systematic approach is needed to ensure prompt diagnosis.
育龄期女性的病态肥胖呈上升趋势，此类人群接受减重手术的数量也随之增加。因此，需要特别关注孕期潜在的术后并发症，尤其是在接受 Roux - en - Y 胃旁路术（RYGB）之后。我们在此展示我们的小病例系列以及对肥胖症孕妇的管理建议。本研究的目的是回顾我们机构的经验，并提出针对 RYGB 术后出现腹痛和/或呕吐的孕妇的处理流程。
经机构审查委员会批准，于 2010 年至 2013 年在一家单中心机构进行了回顾性病历审查。收集并审查了有 RYGB 病史且出现腹部不适的孕妇的临床表现、体格检查结果、实验室值、影像学检查、术中发现以及母婴的临床结局等数据。
共确定了 5 名患者。患者年龄在 22 - 34 岁之间（平均 28.4 岁）。孕周在 9 - 31 个月之间（平均 19.2 个月）。就诊时的平均体重指数为 30.3 kg/m²。5 名患者中，4 名出现腹痛，1 名出现顽固性呕吐。4 名患者接受了手术。1 名患者成功出院。2 名患者因粘连导致梗阻，另外 2 名被发现有内疝。胎儿和母亲均无死亡病例。1 名患者在 28 周时需要早产。
有 RYGB 病史且出现腹痛的孕妇应紧急评估是否存在内疝或梗阻。需要一种系统的方法来确保及时诊断。
