Document Type
Conference Proceeding
Publication Date
5-3-2024
Abstract
Introduction: Roux-en-Y gastric bypass (RYGB) is a standard surgical procedure used to treat morbid obesity. Although RYGB is generally considered safe, it's essential to remain vigilant in identifying and addressing rare complications such as splenic infarction. Splenic infarction is a primarily silent condition, and because many cases go undiagnosed, the exact incidence of the condition is obscure and likely underestimated. Similarly, the incidence and severity of these rare conditions in the postoperative period for bariatric surgeries are still unknown. Case presentation: A 31-year-old female with morbid obesity underwent RYGB six weeks before presentation with acute abdominal pain, nausea, and a 15 lb weight loss since surgery. The pain, located in the middle of the abdomen and radiating to the back and the shoulder, had progressively worsened overnight. The patient denied alleviation of pain with bowel movements and reported no vomiting. Vitals were stable. Patient labs revealed chronic microcytic anemia; other parameters, including WBC, PLT, amylase, lipase, and electrolytes, were unremarkable. A CT abdomen/pelvis showed small bowel dilatation involving proximal small bowel loops with post-surgical changes, indicative of small bowel obstruction. Additionally, a small wedge-shaped hypodensity within the spleen was suggestive of a small splenic infarct Discussion: Splenic infarction is a rare and serious complication associated with hematological disorders, trauma, and vascular interventions, particularly after laparoscopic procedures and the use of energy vessel sealing devices. Excessive use of tissue sealing systems can elevate the risk of splenic injury. Prevention involves avoiding frequent mobilization of connective tissue around vascular structures. Diagnosis is often incidental through CT scans, and while most cases are asymptomatic, complications like hemorrhage, rupture, or abscess may require surgical intervention. A nonoperative approach is considered, with surgery recommended for persistent symptoms or complications. Patients undergoing bariatric surgery should be alert to sudden abdominal pain, especially if radiating from the left upper quadrant to the left shoulder. Uncomplicated cases typically resolve within 7-14 days. Treatment varies based on underlying conditions, with options ranging from careful monitoring to surgical assessment, depending on the severity of symptoms and complications. Clinical significance: This case highlights the need for increased awareness of potential vascular complications, such as splenic infarction, in patients undergoing RYGB. Timely recognition and intervention are crucial for optimal patient outcomes. Surgeons should exercise caution, particularly in the use of tissue sealing systems, to prevent unnecessary mobilization of connective tissue around vascular structures. Further research is required to determine the incidence and severity of visceral infarction in patients undergoing bariatric surgeries.
Recommended Citation
Arshad K, Alamro Y, Latif R, Mahameed Z, Nasser Rahal O, John R. Splenic infarct following Roux-en-Y gastric bypass surgery. Presented at: American College of Physicians Michigan Chapter and Society of Hospital Medicine Michigan Chapter 2024 Resident and Medical Student Day; 2024 May 3; Troy, MI
Comments
American College of Physicians Michigan Chapter and Society of Hospital Medicine Michigan Chapter 2024 Resident and Medical Student Day, May 3, 2024, Troy, MI