Jejunojejunostomy intussusception following conversion from gastric sleeve to gastric bypass: a case report

A 46-year-old woman presented 15 months after laparoscopic conversion of sleeve gastrectomy to Roux-en-Y gastric bypass with acute abdominal pain and lactic acidosis. Computed tomography demonstrated free intraperitoneal air and mesenteric swirl sign concerning for jejunojejunal intussusception. Emergent laparoscopy revealed retrograde intussusception at the jejunojejunostomy with three bowel perforations and feculent peritoneal contamination. After reduction, intraoperative assessment confirmed bowel viability with successful reperfusion, allowing primary two-layer repair of enterotomies rather than segmental resection. A Brolin stitch was placed to prevent recurrence, and the incidentally discovered Petersen space defect was closed with permanent suture. Despite developing postoperative septic shock requiring vasopressor support and intensive care, the patient recovered completely with preserved bowel length and normal function at follow-up. This case highlights the importance of prompt surgical intervention for post-bariatric intussusception and demonstrates that primary repair may be feasible when careful intraoperative assessment confirms bowel viability.