Roux-en-Y gastric bypass in the setting of congenital malrotation: a report and review of the literature.

A Roux-en-Y gastric bypass (RYGB) is the gold standard for weight loss surgery, with>220,000 bariatric cases performed in 2009 [ [1] ASMBS.org [homepage on the Internet]. Gainesville, FL: American Society for Metabolic & Bariatric Surgery; 2013 Available from: www.asmbs.org/ Google Scholar ]. Because of the anatomic reconfiguration of a RYGB, internal hernias are a well-described complication that may result in obstruction, bowel necrosis, perforation, and severe sepsis, progressing to death if not recognized and treated in a timely manner. Other anatomic anomalies, such as adult malrotation or nonrotation, although rare, may significantly complicate both the initial creation of a bypass as well as any reoperative procedures. We report a case of cecal volvulus and obstruction in a patient with a recent history of RYGB who was found to have malrotation at the time of emergent exploration.