LAUSR

A 42-year-old female with a history of a laparoscopic one-anastomosis gastric bypass (OAGB), laparoscopic cholecystectomy, and recurrent marginal ulcers presented to the hospital with 1 week of abdominal pain, nausea, and bilious emesis. She also reported subjective fevers, chills, and diarrhea. Initial laboratory workup was unremarkable. However, subsequent computerized tomography (CT) of the abdomen and pelvis was remarkable for intussusception of her gastric remnant and proximal duodenum, into her distal duodenum (Fig. 1). She was taken to the operating room where diagnostic laparoscopy confirmed the CT findings. The remnant stomach was dilated (Fig. 2) and difficult to handle laparoscopically; due to concern for injury to nearby viscera while attempting reduction, the decision was made to convert to an open operation. A small upper midline laparotomy incision was made and the remnant stomach eviscerated. A dense adhesion from the remnant stomach to the bypass anastomosis was found and sharply divided. The remnant stomach was difficult to reduce given the length of intussusception and its associated edema. Given concern for recurrence, a remnant gastrectomy was performed (Fig. 3) with transection at the first portion of the duodenum distal to the pylorus. An intraoperative endoscopy was performed and demonstrated a normal gastric pouch and anastomosis without evidence of a marginal ulcer. The patient did well postoperatively and was discharged on postoperative day two. Pathology of the resected specimen was significant for chronic gastritis, some reactive epithelial changes in the duodenum, and serosal adhesions.