- Roux-en-y is the most commonly performed gastric bypass operation for morbid obesity
- Procedure: 1. Upper stomach divided 2. Upper jejunum divided and distal end (Roux limb) anastamosed to stomach pouch 3. Proximal end of divided jejunum (excluded Roux limb) attached to Roux limb (Image source: Annals of Emergency Medicine, v 47, n 2, Feb 2006)
- Even with significant intra-abdominal pathology, the abdominal examination in the morbidly obese is often unrevealing. Have low threshold for obtaining imaging studies
- Given the limited volume of the gastric pouch decrease the volume and rate of oral contrast administration.
- If abdominal CT is normal and patient still having abdominal pain, consider internal hernia causing obstruction of the excluded Roux limb. Consider surgical consult and exploration.
Source
Edwards, E MD et al. "Presentation and Management of Common Post-Weight Loss Surgery Problems in the Emergency Department." Annals of Emergency Medicine. v 47, n 2. Feb 2006.