Abstract text (incl. references and figure legends)
Internal hernia is one of the most common late surgical post-operative complications after bariatric surgery, especially in Roux-en-Y reconstructions. Ceriani described in 2017 a new (bariatic) procedure, that was designed to treat side effects (invalidating proctologic sequelae and chronic diarrhoea) and/or insufficient weight loss/weight regain after Biliopancreatic Diversion (BPD). This type of reconstruction (Ceriani"s Procedure – CP) may resemble the biliopancreatic reconstruction in a distal Roux-en-Y gastric bypass (RYGB). A 57-year-old woman that underwent to CP in2020 due to inadequate weight loss. She presented to our Emergency Department in 2021 with severe abdominal pain and fever, denied any nausea or vomiting, normal bowel movement and diuresis. She denied any trauma or trigger for the pain. Physical exam was significant for abdominal distention, tenderness to palpation mainly in the left upper quadrant and mesogastrium. Due to these findings, the patient was sent for a CT of the abdomen and pelvis with intravenous contrast which showed findings compatible with bowel obstruction. Diagnostic laparoscopy was attempted emergently and confirmed bowel obstruction due to internal hernia. The patient underwent to adhesion lysis, internal hernia reduction and closure of inframesenteric defects as to prevent reoccurrence. Rapid surgical treatment is key to preventing bowel infraction necessitating resection. Presentation of bowel obstruction due to internal hernia in a patient with a story of previously bariatric surgery is variable, and while CT scans and physical examination may be helpful, the definitive diagnosis is, often, intraoperatively during emergency surgical exploration for "acute abdominal pain". CP, like classical RYGB reconstruction, may lead to internal hernias.
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