Early small bowel obstruction by phytobezoar related to zopiclone induced amnesia after revisional Roux-en-Y gastric bypass: a case report.

Abstract

This case report details an unusual instance of small bowel obstruction occurring within 48 h after a successful Roux-en-Y gastric bypass (RYGB) procedure. A 59-year-old woman, who had undergone a revisional RYGB and was discharged 24 h post-surgery, returned to the emergency department with acute epigastric pain and vomiting at the 48-h mark. A contrast computed tomography scan revealed dilated small bowel loops, right pleural effusion, and some free gas. An emergency laparoscopy identified an obstruction at the jejunojejunal anastomosis caused by undigested food, including seeds. The obstructive material was removed, and the anastomosis was reconstructed. Subsequent psychiatric evaluation revealed the patient's abuse of zopiclone, taken at four times the recommended dose. This misuse likely led to anterograde amnesia, resulting in unreported dietary indiscretions. This case underscores the importance of comprehensive medication history and patient education to mitigate risks associated with medication misuse and non-compliance.