Blood clot obstruction of the jejunojejunostomy after laparoscopic gastric bypass

Abstract

Background: Acute jejunojejunostomy (JJ) obstruction after laparoscopic gastric bypass secondary to the formation of an intraluminal blood clot is a rare event. We analyzed our experience with such complications from a large consecutive patient series at a university hospital that is a referral center for bariatric surgery.

Methods: A retrospective review of patient data in a register of all patients who had undergone gastric bypass from June 2004 to March 2011 was performed. Reoperations were analyzed for the cause and findings. The patients received routine postoperative administration of low-molecular-weight heparin.

Results: Of 1066 patients, 5 (.5%; 4 women and 1 man), who had undergone laparoscopic gastric bypass, with a median body mass index of 42 kg/m(2) (range 40-46), underwent reoperation for obstruction of the JJ secondary to a blood clot. The indications for reoperation were signs of bleeding, nausea, or findings on abdominal computed tomography. The time of reoperation was 1, 1, 2, 3, and 11 days after the primary procedure. All patients underwent reoperation by laparoscopy, with evacuation of the blood clot through an opening of the suture or staple lines without additional revision of the JJ. The gastric remnant was decompressed using a percutaneously placed gastrostomy tube. One patient had gastric leakage from the staple lines (blowout) that necessitated several later revisions for subcutaneous abscesses. Another patient developed acute pancreatitis.

Conclusion: Blood clots can cause early obstruction of the JJ after gastric bypass. Awareness of this potentially rapidly progressive and life-threatening complication will allow immediate intervention and reduce the risk of serious sequelae.