Internal hernia following laparoscopic Roux-en-Y gastric bypass during pregnancy: A case report

Antiobesity operations, particulary the Roux-en-Y gastric bypass are increasing throughout the world. In the United States more than 200,000 operations were performed in 2012 with up to 50% involving women of reproductive age.

As a result, pregnancy after gastric bypass is becoming much more common.

At 34 weeks of gestation, a 27-year-old-woman (GIII/PII) presented at the university hospital with severe abdominal pain in the right flank and hypochondrium. She had undergone Roux-en-Y gastric bypass surgery 2,5 years before for a body mass index of 45 kg/m2 and lost about 50 kg. When she presented in our hospital the BMI was 28 kg/m2. Physical examination revealed normal vital signs, right upper quadrant tenderness without guarding or rebound. Her laboratory results were within normal limits. The fetal heart rate was 160bpm. An ultrasound revealed a III ° hydronephrosis of the right kidney. Despite analgetics and spasmolytics, the pain reoccured so the insertion of a double J-catheter was performed.

After the procedure the patient began to plain about epigastric pain with radiation in the lower abdomen, especially in upright position. The laboratory results were still within normal limits. No improvement of pain occured by opiod sedation; so a laparascopic diagnosis was decided to evaluate a suspected internal hernia 36h after the first symptoms. The laparoscopy was quickly converted into a laparotomy through a midline incision. An internal hernia of the common channel in Petersen's space was found. There was yet no evidence of bowel infarction or necrosis, so the hernia was reduced and the defect was closed. The postoperative period was uneventful and she was discharged 8 days after her surgery without any obstetrical complications. At 39 weeks of gestation a healthy baby was delivered by ceasarean section.

The possibility of an internal hernia should always be considered in pregnant women with history of gastric bypass presenting with abdominal pain