Fatal Fulminant Pancreatitis After Laparoscopic Gastric Bypass Surgery |
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Authors: | Cunchuan Wang Yixing Ren Jun Chen Youzhu Hu Jingge Yang Peng Xu Yunlong Pan Jinyi Li |
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Institution: | (1) The Center of Minimally Invasive Surgery, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China |
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Abstract: | Current widespread application of laparoscopic techniques in Roux-en-Y gastric bypass (RYGBP) is making surgical safety an
increasingly important issue. We report one case that resulted in death due to postoperative fulminant acute pancreatitis
after laparoscopic RYGBP was performed when this procedure was still relatively new in China. The patient was a chronically
obese 19-year-old male. Weight loss medications had been ineffective, and preoperative body mass index was 40.7. Preoperative
examination revealed moderate steatohepatitis. Laparoscopic RYGBP (LRYGBP) was performed. Early manifestations of clinical
shock appeared 13 h after the laparoscopic surgery. A second laparoscopic examination showed small-vessel hemorrhage at the
posterior wall of the jejunojejunal anastomosis, with blood clot formation resulting in Roux limb and afferent loop obstruction.
Fulminant acute pancreatitis developed in the patient 18 h after the second surgery. The patient died 15 days later from systemic
multiorgan insufficiency. LRYGBP (postcolon) is a technically demanding procedure for surgeons who are not experienced in
this operation. In addition, surgical tolerance is reduced in morbidly obese patients. Therefore, special care should be taken
during surgery, and hemostasis must be achieved at all bleeding sites. Increased perioperative surveillance allows for early
detection and management of severe complications. |
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Keywords: | Morbid obesity Gastric bypass Laparoscopy Severe acute pancreatitis |
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