Background

A 46-year-old female with past medical history of laparoscopic sleeve gastrectomy 5 years ago in Tijuana Mexico and recently underwent what was described by her as a conversion from sleeve to standard gastric bypass in Tijuana Mexico, presents on postoperative day 4 with tachycardia, severe abdominal pain, and bilious emesis. Since surgery she was not able to tolerate any oral intake and had significant abdominal pain which improved after each episode of bilious emesis. She was told to have a postoperative ileus and she was sent back to the United States. She presented to the emergency department straight from the airport. A CT scan demonstrated dilated and decompressed loops of small bowel. The configuration on CT was unusual for a gastric bypass and consistent with single anastomosis gastric bypass. She was taken emergently to the operating room due to the CT scan findings and significant abdominal tenderness on physical examination. In the operating room, she was found to have afferent loop syndrome and the entire afferent segment was back walled during the index case during the creation of the anastomosis. Intraoperative endoscopy was performed and confirmed complete occlusion of the afferent limb. The entire gastrojejunostomy anastomosis was resected and the single anastomosis gastric bypass was converted to a standard roux-en-y gastric bypass. The patient did well postoperatively with an unremarkable upper gastrointestinal series on postoperative day 1. She was started on clear liquids diet without any issues and discharged home on postoperatively day 2.