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Intussusception After Roux-en-Y Gastric Bypass : Correlation Between Radiological and Operative Findings

Zaigham, Hassan LU orcid ; Ekelund, Mikael LU ; Lee, Daisy LU ; Ekberg, Olle LU and Regnér, Sara LU orcid (2023) In Obesity Surgery 33(2). p.475-481
Abstract

Introduction: Intussusceptions diagnosed on computed tomography (CT) scans in Roux-en-Y gastric bypass (RYGB) patients could cause serious small bowel obstruction (SBO) or be an incidental finding. The objective of this study was to correlate radiological findings with clinical outcomes to differentiate intussusceptions requiring emergent surgery for SBO. Methods: A search for acute abdominal CT scans reporting intussusceptions in RYGB patients between 2012 and 2019 at Skåne University Hospital, Malmö, Sweden, retrieved 35 scans. These were independently reevaluated by two radiologists for the length and location of the intussusception, whether oral contrast passed through, proximal bowel dilatation, and signs of internal herniation.... (More)

Introduction: Intussusceptions diagnosed on computed tomography (CT) scans in Roux-en-Y gastric bypass (RYGB) patients could cause serious small bowel obstruction (SBO) or be an incidental finding. The objective of this study was to correlate radiological findings with clinical outcomes to differentiate intussusceptions requiring emergent surgery for SBO. Methods: A search for acute abdominal CT scans reporting intussusceptions in RYGB patients between 2012 and 2019 at Skåne University Hospital, Malmö, Sweden, retrieved 35 scans. These were independently reevaluated by two radiologists for the length and location of the intussusception, whether oral contrast passed through, proximal bowel dilatation, and signs of internal herniation. Clinical outcome in terms of emergency surgery and the diagnosis was determined through chart review. Results: Out of 35 acute patients, 9 patients required emergency surgery within 24 h. Intussusception caused SBO in five patients, and one patient had an internal herniation, while three patients had unremarkable findings. Eight patients were evaluated for intermittent pain with five unremarkable laparoscopies, while 18 patients had intussusceptions as incidental findings. Intussusception length on CT as measured by radiologists O.E. and D.L. predicted acute bowel obstruction (p =.014 and p <.001). A 100 mm threshold predicted bowel obstruction with a sensitivity of 80% and 100% and a specificity of 93% and 86% by radiologists O.E. and D.L., respectively. Proximal bowel dilatation predicted SBOs of any cause as well as SBO caused by an intussusception (all p <.05). Conclusion: Intussusception length > 100 mm on CT in RYGB patients is an easy and valuable sign indicating SBO that may require emergent surgery.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Abdominal pain, Bariatric surgery, Computed tomography, Gastric bypass, Intestinal obstruction, Intussusception
in
Obesity Surgery
volume
33
issue
2
pages
475 - 481
publisher
Springer
external identifiers
  • pmid:36474098
  • scopus:85143421566
ISSN
0960-8923
DOI
10.1007/s11695-022-06377-2
language
English
LU publication?
yes
id
afda0cf5-ee8b-4dbb-973a-73f246fd2cc9
date added to LUP
2023-01-30 12:33:32
date last changed
2024-07-08 15:40:48
@article{afda0cf5-ee8b-4dbb-973a-73f246fd2cc9,
  abstract     = {{<p>Introduction: Intussusceptions diagnosed on computed tomography (CT) scans in Roux-en-Y gastric bypass (RYGB) patients could cause serious small bowel obstruction (SBO) or be an incidental finding. The objective of this study was to correlate radiological findings with clinical outcomes to differentiate intussusceptions requiring emergent surgery for SBO. Methods: A search for acute abdominal CT scans reporting intussusceptions in RYGB patients between 2012 and 2019 at Skåne University Hospital, Malmö, Sweden, retrieved 35 scans. These were independently reevaluated by two radiologists for the length and location of the intussusception, whether oral contrast passed through, proximal bowel dilatation, and signs of internal herniation. Clinical outcome in terms of emergency surgery and the diagnosis was determined through chart review. Results: Out of 35 acute patients, 9 patients required emergency surgery within 24 h. Intussusception caused SBO in five patients, and one patient had an internal herniation, while three patients had unremarkable findings. Eight patients were evaluated for intermittent pain with five unremarkable laparoscopies, while 18 patients had intussusceptions as incidental findings. Intussusception length on CT as measured by radiologists O.E. and D.L. predicted acute bowel obstruction (p =.014 and p &lt;.001). A 100 mm threshold predicted bowel obstruction with a sensitivity of 80% and 100% and a specificity of 93% and 86% by radiologists O.E. and D.L., respectively. Proximal bowel dilatation predicted SBOs of any cause as well as SBO caused by an intussusception (all p &lt;.05). Conclusion: Intussusception length &gt; 100 mm on CT in RYGB patients is an easy and valuable sign indicating SBO that may require emergent surgery. <br/></p>}},
  author       = {{Zaigham, Hassan and Ekelund, Mikael and Lee, Daisy and Ekberg, Olle and Regnér, Sara}},
  issn         = {{0960-8923}},
  keywords     = {{Abdominal pain; Bariatric surgery; Computed tomography; Gastric bypass; Intestinal obstruction; Intussusception}},
  language     = {{eng}},
  number       = {{2}},
  pages        = {{475--481}},
  publisher    = {{Springer}},
  series       = {{Obesity Surgery}},
  title        = {{Intussusception After Roux-en-Y Gastric Bypass : Correlation Between Radiological and Operative Findings}},
  url          = {{http://dx.doi.org/10.1007/s11695-022-06377-2}},
  doi          = {{10.1007/s11695-022-06377-2}},
  volume       = {{33}},
  year         = {{2023}},
}