Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Dr. Ignacio Morones Prieto O 3000, 64710, Monterrey, Mexico.
Especialidades Bariátricas, Avenida de la Industria 300, Torre C, Oficina 8, Punto Central, 66279, San Pedro Garza García, Mexico.
Clin J Gastroenterol. 2020 Dec;13(6):1111-1115. doi: 10.1007/s12328-020-01183-8. Epub 2020 Jul 10.
We presented a case of a 64-year-old female patient with a history of gastric bypass that presented with bowel obstruction due to a bezoar. She arrived at the emergency department, referring to severe abdominal pain, nausea, and vomiting. Abdominal X-ray reported gastric distention and hydro-air levels. CT scan reported swirling of the mesentery vessels and a collapsed intestinal loop, mimicking an internal hernia. Laparotomy was accomplished, which shows obstruction at 60 cm from the ileocecal valve. An enterolithotomy was performed, and a 6 × 6 cm phytobezoar was extracted. The patient had a satisfactory postoperative outcome, discharging her home on the fourth postoperative day. On a 12 month-follow up, the patient is doing well with no further complications. Gastric bypass continues to be one of the most performed bariatric procedures with low complication rates. It is important to note that not all intestinal obstructions in postoperative bariatric surgeries are due to internal hernias or adhesions. The differential diagnosis of intestinal obstruction due to bezoar must be present in patients who underwent bariatric surgery. Nutritional counseling is essential for the follow-up of patients, emphasizing fluid intake and slow chewing, as well as the use of absorbable materials for suture during the surgery.
我们报告了一例 64 岁女性患者，有胃旁路手术史，因毛粪石引起肠梗阻。她因严重腹痛、恶心和呕吐到急诊科就诊。腹部 X 光片报告胃扩张和液气水平。CT 扫描报告肠系膜血管漩涡和肠袢塌陷，类似于内疝。进行了剖腹手术，显示回盲瓣 60cm 处梗阻。进行了肠石切开术，取出了一个 6×6cm 的植物性胃石。患者术后恢复良好，第四天出院。12 个月随访时，患者情况良好，无进一步并发症。胃旁路术仍然是最常进行的减肥手术之一，并发症发生率低。重要的是要注意，术后减肥手术的所有肠梗阻并不都是由于内疝或粘连引起的。在接受过减肥手术的患者中，必须考虑毛粪石引起肠梗阻的鉴别诊断。营养咨询对于患者的随访至关重要，强调液体摄入、缓慢咀嚼以及在手术中使用可吸收缝线材料。
