Rare Stomach Twist and Bowel Block Emerge Eight Years After Gastric Plication

A 25‑year‑old woman presented eight years after bariatric surgery with a gastric volvulus and bowel obstruction, illustrating that rare complications can appear long after the operation. In a case report published on 24 October in Cureus, surgeons identified that broken sutures permitted part of her stomach to unfold, leading to abnormal rotation and migration of gastric tissue into the duodenum.

She had previously undergone laparoscopic gastric plication, a technique that creates a smaller gastric reservoir by folding and suturing the greater curvature without resecting tissue. When she finally sought help, she reported severe abdominal pain, persistent vomiting, and recurrent obstructive jaundice, characterized by yellowing of the skin and eyes due to bile duct blockage.

The simultaneous presence of volvulus and obstruction necessitated urgent surgical intervention. The operative team released the original plication sutures, reduced the twisted stomach, and converted the procedure to a sleeve gastrectomy to restore gastrointestinal continuity.

Post‑operative recovery was uncomplicated, and the patient’s jaundice resolved; the case was documented by Nikolaos Pararas and colleagues from the National and Kapodistrian University of Athens, Greece.

How a Weight‑Loss Procedure Led to a Stomach Twist

Gastric plication reduces gastric volume by folding the greater curvature inward and securing the new configuration with sutures, avoiding any resection or prosthetic material.

The technique aims to promote early satiety by limiting food intake. Yet, the reliance on suture integrity and the altered geometry predispose patients to complications should the folds shift or sutures rupture.

Here, broken sutures permitted the fundus to partially detach from the plicated configuration, resulting in gastric volvulus—a pathological rotation that impeded luminal flow.

Severe volvulus can compromise mesenteric vascular supply, leading to ischemia, necrosis, perforation, and other critical sequelae, as outlined in clinical literature.

Concurrently, the patient developed gastroduodenal intussusception, wherein a segment of the gastrointestinal tract telescopes into the neighboring lumen.

The pathological fundus tissue, rendered thick and fibrotic by chronic folding, prolapsed through the pyloric sphincter into the duodenum, obstructing the intestinal conduit and halting normal digestion.

Why the Complications Were Difficult to Recognize

The coexistence of volvulus and intussusception created an atypical clinical picture; while each entity can impair digestive transit, their simultaneous occurrence after plication presented a complex scenario that demanded operative management.

CT imaging delineated the abnormal gastric rotation and associated luminal narrowing, prompting emergency laparotomy where the surgeons confirmed the pathophysiological changes intra‑operatively.

This report contributes to the limited literature on late complications of gastric plication. Preceding studies include a 2020 case of volvulus after laparoscopic greater‑curvature plication and a 2025 series describing intussusception in two patients undergoing the same procedure.

Additionally, a 2024 case documented gastrogastric intussusception a decade after plication, underscoring that anomalous tissue dynamics can emerge long after the index operation.

While these observations do not quantify incidence, they demonstrate that atypical structural complications can manifest well beyond the immediate postoperative period and may present with nonspecific symptoms.

What Patients Should Know About Long‑Term Risks

Unlike sleeve gastrectomy (which resects a portion of the stomach) or Roux‑en‑Y gastric bypass (which reroutes intestinal flow), gastric plication preserves the native gastric anatomy while merely reshaping it.

Since plication depends on suture‑maintained folds rather than permanent anatomic resection, alteration or failure of these sutures can modify gastric geometry and precipitate complications. The authors advise clinicians to weigh these rare but serious risks when counseling patients about bariatric options.

The case also highlights that late‑onset symptoms such as abdominal pain, vomiting, or jaundice should not be automatically ascribed to non‑surgical etiologies; a thorough history of prior bariatric surgery is essential for accurate diagnostic assessment.

Severe or persistent abdominal pain, repeated vomiting, or a swollen abdomen warrants prompt medical assessment. Yellowing of the skin or eyes also requires evaluation, especially when accompanied by digestive symptoms.

Still, a single case cannot establish the overall safety of a procedure or estimate the risk for other patients. It merely underscores the need for clinicians to remain vigilant for uncommon complications when managing patients with a history of plication.

Key Questions Answered

1. What is gastric volvulus?

Gastric volvulus refers to an abnormal twisting of the stomach that can obstruct luminal passage and compromise blood flow.

2. What is gastric plication?

It is a restrictive bariatric operation in which the greater curvature of the stomach is folded and sutured to create a smaller reservoir without removing tissue.

3. What caused the obstruction in this case?

Ruptured plication sutures permitted partial detachment of the gastric fundus, leading to volvulus and subsequent intussusception of thickened gastric mucosa through the pylorus into the duodenum, thereby blocking the intestinal passage.

4. Can complications develop years after weight‑loss surgery?

Yes. Isolated case reports, including this one, describe rare late‑onset complications such as volvulus and intussusception many years after gastric plication.

5. What symptoms may indicate a digestive obstruction?

Typical warning signs include severe or persistent abdominal pain, vomiting, bloating, and inability to pass stool or gas; these require urgent medical evaluation.

6. Does this case mean gastric plication is unsafe?

No. A single case cannot define overall safety; it merely underscores the need for clinicians to remain vigilant for uncommon complications when managing patients with a history of plication.

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