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<p>Bariatric Roux-en-Y gastric bypass (RYGB) alters the visceral anatomy and physiology substantially and complicates airway management. Small bowel obstruction, a serious late complication of RYGB, bears a high risk of anaesthesia associated pulmonary aspiration. However, the optimal procedure to prevent pulmonary aspiration is unknown. We detail the anaesthesiologic management of three patients with small bowel obstruction after RYGB and discuss specific aspects of pulmonary aspiration. Whereas in the first two cases, pulmonary aspiration appeared despite rapid sequence induction and intubation (RSII), which was likely due to pathophysiological peculiarities of RYGB and anatomical difficulties in placing a nasogastric tube (NGT) within the congested bowel, in the third patient, advancing an NGT beyond the gastric pouch into the alimentary limb, confirmed by abdominal x-ray, allowed for optimized evacuation of enteral content and safe RSII. However, there is still no scientific evidence that in individuals with prior RYGB suffering small bowel obstruction an NGT should be advanced beyond the gastric pouch on a regular basis and confirmed by abdominal x-ray.&#xa0;</p>

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Pulmonary Aspiration and Its Prevention in Patients with Small Bowel Obstruction After Roux-en-Y Gastric Bypass: A Case Report

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年6月14日

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  • Ulrich Limper,
  • Jürgen Meyer-Zillekens,
  • Antonia-Maria Jahnert,
  • Frank Wappler

摘要

Bariatric Roux-en-Y gastric bypass (RYGB) alters the visceral anatomy and physiology substantially and complicates airway management. Small bowel obstruction, a serious late complication of RYGB, bears a high risk of anaesthesia associated pulmonary aspiration. However, the optimal procedure to prevent pulmonary aspiration is unknown. We detail the anaesthesiologic management of three patients with small bowel obstruction after RYGB and discuss specific aspects of pulmonary aspiration. Whereas in the first two cases, pulmonary aspiration appeared despite rapid sequence induction and intubation (RSII), which was likely due to pathophysiological peculiarities of RYGB and anatomical difficulties in placing a nasogastric tube (NGT) within the congested bowel, in the third patient, advancing an NGT beyond the gastric pouch into the alimentary limb, confirmed by abdominal x-ray, allowed for optimized evacuation of enteral content and safe RSII. However, there is still no scientific evidence that in individuals with prior RYGB suffering small bowel obstruction an NGT should be advanced beyond the gastric pouch on a regular basis and confirmed by abdominal x-ray.