P1173 - From Roux-en-Y to Roux-en-WHY: Colonic Enteric Fistula – a Rare Complication of Roux-en-Y Gastric Bypass

Shriraj Patel, DO, Bing Chen, MD, Sara West, DO
Geisinger Medical Center, Danville, PA

Introduction: Postoperative diarrhea is a well-known side effect of Roux-en-Y Gastric Bypass (RYGB), but the etiology can be difficult to identify. Fistulas are an uncommon but well-recognized and potentially severe complication that may manifest as a change in bowel habits. Here, we report an elderly female with a jejuno-colic fistula five years after RYGB, only the second reported case to our knowledge.

Case Description/Methods: A 65-year-old female with a history of Roux-en-Y gastric bypass, internal hernia requiring diagnostic laparoscopy without resection, and endometrial cancer status post hysterectomy was referred to gastroenterology for a 4-month history of postprandial watery diarrhea and a 15-pound weight loss. She reported chronic constipation and abdominal pain prior to the onset of diarrhea. Colonoscopy identified a fistula between the transverse colon and the small bowel (Figure A). A computed tomography scan of the abdomen and pelvis with intravenous and oral contrast revealed the specific location of the fistula between the proximal Roux limb and the transverse colon (Figure B). Pre-operative upper endoscopy identified the fistula from the jejunum, just beyond the gastro-jejunal (GJ) anastomosis, to the transverse colon. The patient underwent a takedown of the fistula with resection and revision of the GJ anastomosis with resolution of the diarrhea.

Discussion: Patients with chronic diarrhea after bariatric surgery require a broad differential diagnosis. The patient was ultimately diagnosed with a jejuno-colic fistula, necessitating surgical intervention with a takedown of the fistula and revision of the Roux-en-Y. Multiple intra-abdominal surgeries likely increased the patient’s risk for this complication. While diarrhea is common after RYGB, clinicians should have a high index of suspicion for less common complications such as a colonic-enteric fistula described here. Prompt diagnosis can prevent serious sequelae such as sepsis and bowel obstruction. Further studies are needed to establish optimal treatment strategies for this rare but potentially severe complication of RYGB.



Disclosures:


Shriraj Patel, DO, Bing Chen, MD, Sara West, DO. P1173 - From Roux-en-Y to Roux-en-WHY: Colonic Enteric Fistula – a Rare Complication of Roux-en-Y Gastric Bypass, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.