Review finds hemobezoar obstruction is rare after Roux-en-Y gastric bypass

A systematic review of six studies covering 7,669 minimally invasive Roux-en-Y gastric bypass procedures identified 29 hemobezoar-related jejunojejunostomy obstructions. Cases usually presented within 72 hours after surgery; the authors describe CT diagnosis and operative management reported across the included studies.

Review included 29 cases among 7,669 procedures.
Crude incidence was 0.38%; estimates varied across studies.
Presentation usually occurred within 72 postoperative hours.
No deaths were reported; morbidity included several complications.

Hemobezoar-related obstruction at the jejunojejunostomy is a rare early complication of minimally invasive Roux-en-Y gastric bypass (RYGB). This systematic review followed PRISMA 2020 guidance and searched PubMed/MEDLINE, Embase and CENTRAL through February 2026. Six studies met inclusion criteria, covering 7,669 procedures and 29 cases. Because there were no comparative cohorts, the authors summarized findings descriptively.

The crude incidence was 0.38%, with study-level estimates ranging from 0.09% to 1.94%. Presentation was typically within 72 hours of surgery and commonly involved tachycardia, nausea, vomiting, abdominal pain, falling hematocrit or gastrointestinal bleeding. CT with intravenous contrast was the predominant diagnostic test; reported findings included dilation of the excluded stomach and proximal limbs, with hyperdense material at the jejunojejunostomy. Management in the reports shifted from laparotomy and anastomotic revision toward laparoscopic clot evacuation, with revision when anastomotic compromise, leakage, ischemia or ongoing bleeding was identified. Remnant-stomach decompression was also emphasized.

No deaths were reported among the 29 patients, but complications included abscesses, anastomotic or staple-line problems, pancreatitis, respiratory complications, readmission and repeat surgery. The review suggests a recognizable early postoperative presentation, but its conclusions are limited by the small number of cases and retrospective evidence; prospective validation is needed.

In practice

In adults who develop early obstruction after minimally invasive Roux-en-Y gastric bypass, hemobezoar at the jejunojejunostomy is a rare possible cause, often presenting within 72 hours with obstructive symptoms and evidence of bleeding. The review describes CT with intravenous contrast as the predominant diagnostic modality and reports operative clot evacuation, remnant decompression and selective anastomotic revision. These findings may inform recognition and evaluation, but they do not establish a preferred strategy: evidence comes from six studies and 29 cases, without comparative cohorts.

AI-generated clinical interpretation · Not editor-reviewed

AI summary · Not yet editor-reviewed

Is this summary clinically accurate?

Help fellow clinicians: your rating sends inaccurate summaries straight to our editors.

Source

Surgical Endoscopy: Hemobezoar-related jejunojejunostomy obstruction after minimally invasive Roux-en-Y gastric bypass: a systematic review ↗

This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.