Early-Pregnancy Intussusception with Perforation after Roux-en-Y Gastric Bypass: A Case Report.

Abstract

Background: Intussusception is a rare late complication of Roux-en-Y gastric bypass (RYGB), and it is exceptionally uncommon to occur during pregnancy. Its diagnosis is difficult due to the overlapping of symptoms from normal pregnancy and limited options for imaging modalities. This case is notable for presenting in early pregnancy with bowel perforation and being successfully managed with emergency laparoscopy.

Case presentation: A 36-year-old female patient at 15 weeks of gestation (gravida 2, para 1, and living 1) was admitted with sudden onset of severe abdominal pain, weakness, and one episode of vomiting. Her history included RYGB, cesarean delivery, and cholecystectomy. Vital signs and laboratory tests were normal. Ultrasound examination of the abdomen revealed a dilated, noncompressible bowel loop in the right lower quadrant, which raised suspicion of obstruction. Laparoscopy showed marked dilation at the jejunojejunal anastomosis, a small anterior bowel perforation, and retrograde intussusception approximately 20 centimeters distal to the anastomosis. The perforation was repaired, the intussusception was reduced, and bowel viability was confirmed. Recovery was uneventful, with no maternal or fetal complications.

Conclusions: This case highlights that intussusception should be taken into consideration in pregnant patients who have undergone gastric bypass and now present with acute abdominal pain. Ultrasound can be a useful diagnostic tool when other imaging modalities are restricted. Early laparoscopic intervention is critical to prevent severe complications and support favorable maternal and fetal outcomes.