Blood clot causing small bowel obstruction after Roux en-Y Gastric bypass: a Case Report & Review of Literature

Rami R. Mustafa, Leena Khaitan, Adel Alhaj Saleh, Heba Elghalban, Ayush Kedia, Mujjahid Abbas


The gold standard procedure and most commonly performed bariatric surgery internationally is the Roux En-Y Gastric Bypass (RYBG) surgery. A major complication of the RYGB is small bowel obstruction (SBO; 5% incidence), most frequently caused by intra-abdominal adhesions (65–75%), followed by internal hernias, volvulus, malignancy, intussusception, Crohn’s disease, carcinomatosis, intraluminal blood clot, port site hernias, jejunojejunostomy anastomosis strictures, paralytic ileus, and superior mesenteric artery syndrome. In this review of literature, we present a small bowl obstruction case caused by a blood clot (inside the lumen) at a bleeding site within a jejunojejunostomy staple line of a surgical patient. The patient’s past-medical history is significant for recurrent deep venous thrombosis (DVT) and pulmonary embolism (PE). The SBO was diagnosed by computed tomography (CT) post-operatively and the patient underwent emergent explorative laparoscopy for management. The intraluminal clot that was found upon examination was evacuated by enterotomy followed by a primary closure with no evidence of continued active bleeding and without need for revision of the jejunojejunal anastomosis. It was concluded that the anti-coagulant medication (Enoxaparin 50 mg BID) being administered to the patient most likely precipitated the intraluminal bleeding at the anastomosis. Based on our findings, early diagnosis and management of SBO in the early perioperative period could likely reduce the percent of this in bariatric patients.