Hari Movva, MD1, Lucia Gallego, DO1, Keegan Colletier, MD1, Brooke Corning, MD1, Bianca Rangel, 2 1University of Texas Medical Branch, Galveston, TX; 2John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX
Introduction: Foreign body ingestion, whether accidental or incidental, can lead to serious complications requiring intervention. Most foreign bodies pass through the GI tract spontaneously; however, some cases require endoscopic removal or even surgery. Complications such as impaction, perforation, and obstruction can occur, particularly in patients with pre-existing GI abnormalities or those who have undergone bariatric surgery. Bariatric procedures, while effective for obesity, can lead to postoperative issues like gastric hypomotility, stenosis, and strictures, which may mimic obstructive symptoms. In this case, a patient with a history of gastric bypass was presented with obstructive symptoms due to a food bezoar overlying a suspected narcotic body packet. This case underscores the importance of considering foreign body complications in bariatric patients and the need for prompt endoscopic intervention to improve outcomes.
Case Description/Methods: A 49-year-old male with past medical history of morbid obesity, pernicious anemia and surgical history of Roux-en-Y gastric bypass presented with 3 months of persistent nausea, vomiting, weight loss, and intolerance to oral intake. CT abdomen pelvis showed dilated distal esophagus and gastric pouch with collapsed jejunum distal to gastrojejunostomy anastomosis suspicious for gastrojejunostomy stenosis. Esophagogastroduodenoscopy (EGD) showed healthy anastomosis and an obstructing food bezoar, whose removal uncovered a latex balloon, which was subsequently removed with resolution of symptoms.
Discussion: Foreign body ingestions are typically asymptomatic but can lead to complications such as impaction, perforation, and obstruction, particularly in areas of gastrointestinal angulation or narrowing, and anatomical variations such as those seen with prior GI surgeries. Bariatric surgeries are effective for obesity treatment but alter gut physiology, leading to unique postoperative complications such as anastomotic strictures, ulceration, and bezoars causing obstruction. However, little to no literature has shown obstruction due to a foreign body. Typically, symptoms include abdominal pain, nausea, and vomiting, Management often involves endoscopic removal, except for narcotic packets, which may require surgical intervention to avoid rupture and leakage. We describe a rare case of gastric bypass patient presenting with obstruction due to a suspected narcotic packet successfully managed with endoscopic removal, highlighting novel challenges in bariatric care.
Figure: Figure 1a: Roux-en-Y gastric bypass anastomotic narrowing on CT . (a) Axial and (b) Coronal CT images after oral and intravenous contrast material administration show a dilated distal esophagus and gastric pouch with fluid and a relatively collapsed jejunum distal to the gastrojejunostomy anastomosis suspicious for gastrojejunostomy stenosis. Figure 1b: Roux-en-Y gastric bypass anastomotic narrowing on CT . (a) Axial and (b) Coronal CT images after oral and intravenous contrast material administration show a dilated distal esophagus and gastric pouch with fluid and a relatively collapsed jejunum distal to the gastrojejunostomy anastomosis suspicious for gastrojejunostomy stenosis. Figure 1C: Upper GI endoscopy reveals apparent food bezoar in the gastric body, intact staple line, and healthy gastrojejunal anastomosis. Figure 1D: Upper GI endoscopy revealed a foreign body (suspected narcotic body packet) in the stomach as the apparent food bezoar was pulled into the esophagus with a Roth net.
Disclosures:
Hari Movva indicated no relevant financial relationships.
Lucia Gallego indicated no relevant financial relationships.
Keegan Colletier indicated no relevant financial relationships.
Brooke Corning indicated no relevant financial relationships.
Bianca Rangel indicated no relevant financial relationships.
Hari Movva, MD1, Lucia Gallego, DO1, Keegan Colletier, MD1, Brooke Corning, MD1, Bianca Rangel, 2. P1455 - Roux-en-Y Gastric Bypass Complicated by Obstruction-Like Symptoms: A Case Study, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
