- 作者：Raú ; l Leal-Gonzá ; lez ; raul.leal@usa.net ; raul.leal.g@hotmail.com ; Rafael De la Garza-Ramos ; Horacio Guajardo-Pé ; rez ; Fernando Ayala-Aguilera ; Roberto Rumbaut
- 关键词：Internal hernia ; Pregnancy ; Gastric bypass ; General surgery ; Obstetrics & gynecology
- 刊名：International Journal of Surgery Case Reports
- 出版年：2013
- 出版时间：2013
- 年：2013
- 卷：4
- 期：1
- 页码：44-47
- 全文大小：172 K
INTRODUCTION
Gastric bypass surgery is the most common obesity surgery procedure in women. Decreased weight loss favors fertility and leads to pregnancy sometimes just months after surgery, raising the risk of developing gastric bypass-related complications during pregnancy, including the formation of internal hernias.PRESENTATION OF CASE
The first patient presented at 37 weeks of gestation with abdominal pain, nausea and vomiting. X-ray revealed multiple air-fluid levels and absence of gas in colon. She underwent a cesarean section and exploratory laparotomy without complications. A Petersen's space internal hernia was found. The second patient presented at 25 weeks of gestation with abdominal pain and nausea. X-ray revealed multiple air-fluid levels and a ¡°U-shaped¡± intestinal loop. She underwent exploratory laparotomy with reduction of an internal hernia also in Petersen's space.
DISCUSSION
Pregnant patients with internal hernias after gastric bypass are usually of young age and with a several-day history of abdominal pain. Surgical exploration is safe and should not be delayed. The literature review showed that maternal death (9 % ) and fetal death (13.6 % ) rates are considerably high.
CONCLUSION
The possibility of an internal hernia should always be considered in pregnant women with history of gastric bypass who present with abdominal pain, in order to prevent catastrophic outcomes such as maternal and/or fetal death.