Cherry Fruit-Stem Stapled into J-J anastomoses during Roux-en-Y Gastric Bypass: A Case Report of a Rare Complication
Author(s): Logan D Glosser, Alexander Young, Justin Smith, Conner V Lombardi, Abdullah Alalwan, Motaz Al-yafi, Stephen Stanek
Roux-en-Y gastric bypass (RYGB) surgery is the gold standard intervention for weight loss in patients with morbid obesity. Although the mortality associated with the procedure is reduced compared to no intervention, complications account for a high percent of associated morbidity.
A 63-year-old female with a history of laparoscopic RYGB 2 years prior presented with a 3-month history of crampy abdominal pain. A CT scan showed an intra-luminal mass near the jejunojejunostomy (JJ) site. Surgical excision of the mass revealed a stalk of tissue stapled into the JJ anastomosis that was identified as a cherry fruit-stem. Unfortunately, the patient returned 3 months later suffering from an incisional hernia, requiring mesh repair.
RYGB is one of the most commonly performed procedures in bariatric surgery. Common complications from this that result in abdominal pain include anastomotic leaks or strictures, cholecystitis, gastrointestinal bleeding, internal herniation, and marginal ulceration. No prior literature discusses intermittent obstructive symptoms secondary to a foreign body anchored by the anastomotic staples. Furthermore, there are currently no universal dietary guidelines for patients in the immediate pre-operative period with regard to avoiding certain foods that could get stapled during the anastomotic construction.
There are two main take-away lessons from this case. First, this case denotes an unusual complication following RYGB surgery requiring surgical intervention in which the stem of a cherry fruit was stapled into the JJ anastomosis causing obstruction-related intermittent abdominal pain. Second, there is a need for standardized guidelines to outline foods to avoid, such as cherries with a stem, leading up to the procedure.