{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T13:09:02Z","timestamp":1760015342942,"version":"3.37.3"},"reference-count":7,"publisher":"Springer Science and Business Media LLC","issue":"12","license":[{"start":{"date-parts":[[2020,9,29]],"date-time":"2020-09-29T00:00:00Z","timestamp":1601337600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,9,29]],"date-time":"2020-09-29T00:00:00Z","timestamp":1601337600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100006390","name":"University of Lausanne","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100006390","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["OBES SURG"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Small bowel obstruction (SBO) due to internal hernia (IH) is a\nwell-known late complication after laparoscopic Roux-en-Y gastric bypass\n(LRYGB), with an incidence between 0.5 and 10% as reported by Iannelli et al.\n(Obes Surg. 17(10):1283\u20136, 2007). It\nis reported most frequently 1\u20132\u00a0years after surgery because of the greater\nweight loss at that time, with rapid loss of the mesenteric fat consequently as\ndiscussed by Stenberg et al. (Lancet. 387(10026):1397\u2013404, 2016). Currently, women constitute more than\n50% of the patients undergoing bariatric surgery and most of them are of\nchildbearing age as reported by the World Health Organization (2015). SBO, due to IH, is a rare\ncomplication during pregnancy, mostly occurring during the third trimester as\ndiscussed by Torres-Villalobos et al. (Obes Surg 19(7):944\u201350, 2009), and can result in fetal and maternal\nmorbidity and even mortality as reported by Vannevel et al. (Obstet Gynecol.\n127(6):1013\u201320, 2016). Moreover, the\nphysiologic changes of pregnancy can mask the symptoms of SBO after LRYGB,\nleading to significant diagnostic and therapeutic delays as detailed by Wax et\nal. (Am J Obstet Gynecol 208(4):265\u201371, 2013). Therefore, an early surgical exploration is necessary\nin this particular and uncommon situation as discussed by Webster et al. (Ann R\nColl Surg Engl 97(5):339\u201344, 2015).<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>A 32-year-old female patient, with Ehlers-Danlos syndrome and\nchronic pain, was in the 28th week of her first pregnancy after bariatric\nsurgery. She had had an antecolic LRYGB 6\u00a0years ago in another institution,\nresulting in a 35-kg weight loss. She presented to the emergency department with\nsevere and persistent epigastric pain associated with nausea and vomiting during\n24\u00a0h. On physical examination, her abdomen was painful and tender at the\nepigastrium and left hypochondrium, and her vital signs were normal. The blood\ntests were in the normal range except the white blood cell count at 12\u2032000\u00a0G\/l.\nThe obstetric and neonatal team was involved, and fetal heart monitoring was\nnormal. Abdominal ultrasonography ruled out other causes of pain. An abdominal\nMRI was performed and displayed a distended proximal small bowel, free abdominal\nfluid, and bowel mesenteric edema in the left upper quadrant with compression of\nthe superior mesenteric vein. Internal hernia with intestinal suffering was\nsuspected, and the patient consented for emergency laparoscopy.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>The laparoscopic exploration, reduction of the internal hernia, and\nclosure of the mesenteric defects are demonstrated step-by-step in the presented\nintraoperative video. The postoperative course was uncomplicated for both\npatient and fetus. Oral feeding was resumed at day 1, with no residual symptom,\nand the patient was discharged on postoperative day 3. At 1-month follow-up, she\nhad no complaint and her pregnancy had resumed a normal course. She delivered a\nhealthy baby at 36\u00a0weeks without any complication.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Internal herniation after LRYGB represents a rare, high-risk\ncomplication during pregnancy. A low threshold for imaging, preferably by\nabdominal MRI, is recommended. Multidisciplinary management, including\nobstetricians and bariatric surgeons, is necessary in order to avoid maternal\nand fetal adverse outcomes. During surgery, recognition of the anatomy is often\ndifficult, and parts of the bowel are distended and fragile. Starting to run the\nbowel backwards from the ileocecal valve is a crucial surgical step for reducing\ninternal hernias during LRYGB, and reduces both the risk to worsen the situation\nand of bowel injury, making its management less hazardous.<\/jats:p>\n<\/jats:sec>","DOI":"10.1007\/s11695-020-04997-0","type":"journal-article","created":{"date-parts":[[2020,9,29]],"date-time":"2020-09-29T20:03:00Z","timestamp":1601409780000},"page":"5177-5178","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Management of a Complicated Internal Herniation After Roux-en-Y\nGastric Bypass in a 28-Week Pregnant Woman"],"prefix":"10.1007","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3348-792X","authenticated-orcid":false,"given":"Theodoros","family":"Thomopoulos","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Styliani","family":"Mantziari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Penelope","family":"St-Amour","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emilie","family":"Uldry","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michel","family":"Suter","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,9,29]]},"reference":[{"issue":"10","key":"4997_CR1","doi-asserted-by":"publisher","first-page":"1283","DOI":"10.1007\/s11695-007-9229-5","volume":"17","author":"A Iannelli","year":"2007","unstructured":"Iannelli A, Buratti MS, Novellas S, et al. Internal hernia as a\ncomplication of laparoscopic roux-en-Y gastric bypass. Obes Surg.\n2007;17(10):1283\u20136.","journal-title":"Obes Surg"},{"issue":"10026","key":"4997_CR2","doi-asserted-by":"publisher","first-page":"1397","DOI":"10.1016\/S0140-6736(15)01126-5","volume":"387","author":"E Stenberg","year":"2016","unstructured":"Stenberg E, Szabo E, Agren G, et al. Closure of mesenteric defects\nin laparoscopic gastric bypass: a multicentre, randomised, parallel, open-label\ntrial. Lancet. 2016;387(10026):1397\u2013404.","journal-title":"Lancet."},{"key":"4997_CR3","unstructured":"World Health Organization. Obesity and overweight. Available at: http:\/\/www.who.int\/mediacentre\/factsheets\/fs311\/en\/.Retrieved. October 4, 2015."},{"issue":"7","key":"4997_CR4","doi-asserted-by":"publisher","first-page":"944","DOI":"10.1007\/s11695-008-9681-x","volume":"19","author":"GM Torres-Villalobos","year":"2009","unstructured":"Torres-Villalobos GM, Kellogg TA, Leslie DB, et al. Small bowel\nobstruction and internal hernias during pregnancy after gastric bypass surgery.\nObes Surg. 2009;19(7):944\u201350.","journal-title":"Obes Surg"},{"issue":"6","key":"4997_CR5","doi-asserted-by":"publisher","first-page":"1013","DOI":"10.1097\/AOG.0000000000001429","volume":"127","author":"V Vannevel","year":"2016","unstructured":"Vannevel V, Jans G, Bialecka M, et al. Internal herniation in\npregnancy after gastric bypass: a systematic review. Obstet Gynecol.\n2016;127(6):1013\u201320.","journal-title":"Obstet Gynecol"},{"issue":"4","key":"4997_CR6","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1016\/j.ajog.2012.08.014","volume":"208","author":"JR Wax","year":"2013","unstructured":"Wax JR, Pinette MG, Cartin A. Roux-en-Y gastric bypass-associated\nbowel obstruction complicating pregnancy-an obstetrician\u2019s map to the clinical\nminefield. Am J Obstet Gynecol. 2013;208(4):265\u201371.","journal-title":"Am J Obstet Gynecol"},{"issue":"5","key":"4997_CR7","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1308\/003588415X14181254789844","volume":"97","author":"PJ Webster","year":"2015","unstructured":"Webster PJ, Bailey MA, Wilson J, et al. Small bowel obstruction in\npregnancy is a complex surgical problem with a high risk of fetal loss. Ann R\nColl Surg Engl. 2015;97(5):339\u201344.","journal-title":"Ann R Coll Surg Engl"}],"container-title":["Obesity Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11695-020-04997-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11695-020-04997-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11695-020-04997-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,29]],"date-time":"2021-09-29T00:53:06Z","timestamp":1632876786000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11695-020-04997-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,29]]},"references-count":7,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["4997"],"URL":"https:\/\/doi.org\/10.1007\/s11695-020-04997-0","relation":{},"ISSN":["0960-8923","1708-0428"],"issn-type":[{"type":"print","value":"0960-8923"},{"type":"electronic","value":"1708-0428"}],"subject":[],"published":{"date-parts":[[2020,9,29]]},"assertion":[{"value":"29 July 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 September 2020","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 September 2020","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 September 2020","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with Ethical Standards"}},{"value":"The authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of Interest"}},{"value":"All procedures performed in studies involving human participants\nwere in accordance with the ethical standards of the institutional and\/or\nnational research committee and with the 1964 Helsinki Declaration and its later\namendments or comparable ethical standards.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Approval"}},{"value":"Informed consent was obtained from all individual participants\nincluded in the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed Consent"}}]}}