Background

47 year-old with BMI of 35.7 kg/m2, obstructive sleep apnea, hypertension, and reflux presenting for gastric bypass. The index operation and hospital course were uneventful, the patient was discharged on POD 1. POD 4, the patient developed crampy abdominal pain and bloating. She went to an outside hospital and was found to be tachycardic with a heart rate in the 130's and a leukocytosis of 13,000. A CT scan found the roux limb to be dilated and air in the remnant stomach. With these findings, we were concerned for an early obstruction at her jejunojenunostomy so she was transferred and taken for an emergent diagnostic laparoscopy. Intra-operatively, the roux limb was dilated with relative decompression of the biliopancreatic limb and common channel. Intra-operative endoscopy found a significant amount of food in her pouch and roux limb. We felt this was causing the obstruction at her JJ. An enterotomy was made on the roux limb and the obstruction was relieved using a foley balloon inserted through the roux limb past the anastomosis. The enterotomy was closed in a single layer using V-lock suture. Repeat endoscopy was performed, leak test was negative and a nasogastric tube was placed into the roux limb. The NG was removed on POD 1 and patient was started on a liquid diet. She tolerated liquids and was discharged home POD 1. She developed a wound infection in the RLQ. This was treated by opening the incision and a short course of antibiotics. Patient has since done well.