nearly 90% of the cases of intussusception in adults are secondary to a pathologic condition that serves as a lead point . although meckel 's diverticulum ( md ) may cause intussusception and small bowel obstruction , it is usually asymptomatic and found incidentally during surgery . it occurs in 1 - 3% of the general population , and typically is found within 100 cm of the ileocecal valve . simple diverticulectomy or segmental resection is preferred for the small bowel since the malignancy rate is low . we present an interesting case of a patient with past surgical history of open roux - en - y gastric bypass who presented with recurrent intussusception after diverticulectomy for incidental md . a 62-year - old female ( body mass index 19.9 kg / m ) with past surgical history of open roux - en - y gastric bypass in 1993 presented to the emergency department with abdominal pain for 1-day . a computed tomography ( ct ) scan was obtained which revealed dilatation of the biliary limb of the roux - en - y gastric with abrupt small bowel tapering in the region of the jejunojejunal anastomosis where there was evidence of small bowel - small bowel intussusception [ figure 1 ] . the jejunojejunostomy appeared normal ; however , approximately 60 cm proximal to the cecum , an md with an intussuscepted segment of small bowel was incidentally discovered . the md was transected with an endo - gia stapler , with care taken to avoid narrowing the lumen . computed tomography abdomen / pelvis with po / intravenous contrast 7/31/2014 on postoperative day 143 , the patient again presented to the emergency room with intermittent abdominal pain for the previous 2 weeks . the jejunojejunostomy was bulbous in appearance and felt to be the cause of the recurrent intussusception . the alimentary limb of the jejunojejunostomy was transected laparoscopically with an endo - gia stapler and anastomosed to the jejunum 25 cm distal to the previous connection in a side - to - side fashion using the endo - gia stapler . bowel intussusception in adults is rare , accounting for 1 - 5% of all bowel obstructions . in children , the etiology is usually benign and can be safely and effectively managed with pneumatic or hydrostatic reduction in 80% of cases . in contrast , adults are much more likely to have a pathologic cause of intussusception , thereby mandating surgical exploration . md is a known cause of small bowel intussusception but is more often asymptomatic , occurring in 1 - 3% of the population . when causing obstruction ; however , it should be resected , either via diverticulectomy or bowel resection . presented a series of 253 patients undergoing laparoscopy for diagnosis and treatment of recurrent small bowel obstruction . there are cases presented in the literature describing intussusception in patients with previous bariatric surgery . daetwiler et al . presented a case of suspected md causing chronic abdominal pain in a patient who had undergone laparoscopic adjustable gastric banding ( lagb ) . md was suspected based on a tc99 scintigraphy showing tracer enrichment of the terminal ileum . during diagnostic laparoscopy , however , md was ruled out , and the chronic pain was ultimately determined to be from displaced an lagb port catheter wrapping around the root of the mesentery . sohn et al . reported an incidental md in 1.2% of 427 patients undergoing open roux - en - y gastric bypass with routine extirpation of the gallbladder and appendix from july 1994 to june 2006 at a tertiary care hospital . our patient had two etiologies for intussusception : md and a dilated , bulbous jejunojejunal anastomosis from previous roux - en - y gastric bypass . certainly , if no md was discovered during the initial operation , we feel the appropriate step would have been to revise the jejunojejunal anastomosis . however , given the presence of the md , the question was whether to resect the md , and if so , whether to simultaneously revise the jejunojejunal anastomosis . given the findings of intussusception at the md we felt this to be the most likely cause of her symptoms . revising the anastomosis at the same time , thereby creating a fresh anastomosis in addition to the separate staple line along the md would have increased her risk of postoperative complications . nonetheless , in retrospect , resecting the md and revising the jejunojejunal anastomosis , although increasing her risk of postoperative complications , could have prevented the need for a second operation .
most cases of intussusception in adults are secondary to a pathologic condition that serves as a lead point . 
 intussusception has been reported in the bariatric literature , typically due to intussusception of the jejunojejunostomy . 
 however , other causes of intussusception should be considered , including a meckel 's diverticulum ( md ) . 
 simple diverticulectomy or segmental resection is the preferred treatment since the malignancy rate is low . 
 we present an interesting case of a patient with past surgical history of open roux - en - y gastric bypass who presented with intussusception . 
 intraoperatively , an md was encountered and treated with diverticulectomy . 
 4 months later , she re - presented with recurrent intussusception and was subsequently taken back to the operating room for revision of her jejunojejunostomy . 
 the postoperative course was uncomplicated .