Department of Surgery, Newark Beth Israel Medical Center, RWJ Barnabas Health, Newark, New Jersey; St. George's University School of Medicine, Grenada, West Indies.
Department of Surgery, Newark Beth Israel Medical Center, RWJ Barnabas Health, Newark, New Jersey.
Surg Obes Relat Dis. 2019 Sep;15(9):1633-1640. doi: 10.1016/j.soard.2019.06.009. Epub 2019 Jun 20.
Improved fertility following a Roux-en-Y gastric bypass (RYGB) can lead to pregnancy and increase the risk of internal herniation. A developing fetus and symptoms of pregnancy can mask the diagnosis and delay intervention, leading to deleterious maternal and fetal consequences. The aim of this systematic review is to summarize the literature regarding internal hernias during pregnancy, their management, and patient outcomes. A comprehensive literature search was undertaken on PubMed and Google Scholar to identify cases of internal hernias presenting during pregnancy after RYGB. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for eligibility and inclusion of articles. Twenty-seven articles, with a total of 59 patients, regarding internal herniation during pregnancy after RYGB were identified. Epigastric pain and nausea and vomiting was the most common presentation. Regardless of orientation of the Roux limb and despite previous closure of mesenteric defects, internal herniation can still occur. A triad of epigastric pain, pregnancy, and a history of RYGB should be a red flag for clinicians to consider internal hernias as a top differential diagnosis. Prompt bariatric consultation and rapid intervention will improve maternal and fetal outcomes.
胃旁路术后（RYGB）生育能力提高可能导致怀孕，并增加内疝的风险。正在发育的胎儿和怀孕症状可能会掩盖诊断并延迟干预，导致母婴不良后果。本系统评价的目的是总结关于 RYGB 后怀孕期间内疝的文献，包括其管理和患者结局。我们在 PubMed 和 Google Scholar 上进行了全面的文献检索，以确定 RYGB 后怀孕期间出现的内疝病例。我们使用了系统评价和荟萃分析的首选报告项目（PRISMA）指南来确定文章的合格性和纳入标准。共确定了 27 篇文章，共 59 例 RYGB 后怀孕期间内疝的病例。上腹痛、恶心和呕吐是最常见的表现。无论 Roux 袢的方向如何，以及尽管先前已关闭肠系膜缺陷，内疝仍可能发生。上腹痛、妊娠和 RYGB 病史的三联征应引起临床医生的警惕，将内疝作为主要鉴别诊断。及时的减重手术咨询和快速干预将改善母婴结局。
