Stomach Volvulus Combined With Small Bowel Obstruction Eight Years After Laparoscopic Gastric Plication: A Case Report

Laparoscopic gastric plication (LGP) is a restrictive bariatric procedure that reduces gastric volume without resection and without the use of staplers or prosthetic materials. We present the case of a 25-year-old female patient who had undergone LGP eight years earlier and presented with acute abdominal pain, vomiting, and recurrent episodes of obstructive jaundice. Computed tomography demonstrated gastric volvulus, and emergency laparotomy revealed a partially unfolded plicated fundus due to ruptured sutures, causing a mixed-type gastric volvulus, together with intussusception of ischemic, hypertrophic gastric mucosa from the plicated fundus through the pylorus into the duodenum, obstructing the duodenal lumen. We took down the plication, reduced the intussuscepted mucosa, and performed a sleeve gastrectomy. The postoperative course was uneventful, and the jaundice resolved. Gastric volvulus and mucosal intussusception causing obstruction are rare but potentially devastating late complications of greater curvature plication. Awareness of this spectrum of complications allows timely recognition and treatment and should be considered when choosing a bariatric procedure.