Small Bowel Intussusception: A Dangerous Sequela of Bariatric Surgery

A 31-year-old woman presented with an acute onset of epigastric abdominal pain accompanied with nausea and vomiting. The pain had awoken her from her sleep. She denied fever or chills, had passed a bowel movement in the previous 24 hours, and had not sustained trauma. The past medical history revealed a Roux-en-Y gastric bypass opera-tion for weight reduction approximately three years ago, followed by weight loss. On physical examination, there was a significant amount of tenderness appreciated in the epigastric region with minimal radiation. Laboratory tests, including a battery of electrolytes, liver function tests, and a complete blood count, revealed only mild hypokalemia (3.3 meq/L (normal range 3.5-5.3 meq/L)). Her white blood cell count was normal. An abdominal radiograph (Figure 1) and a CT scan (Figure 2) were obtained. The abdominal radiograph (Figure 1) revealed marked dilated loops of bowel with scattered air-fluid levels that heightened the suspicion of an impending bowel obstruc-tion. A CT scan (Figure 2) of the abdomen and pelvis with oral contrast and intravenous was obtained. CT showed marked dilatated stomach, duodenum and proximal jeju-num, with non-dilated distal jejunum, ileum, and colon; these findings were indicative of proximal small bowel ob