Case Reports

Extracorporeal Membrane Oxygenation Rescue for Severe Aspiration Pneumonitis in Two Patients after Roux-en-y Gastric Bypass Procedure

^* Department of Surgery, McGovern Medical School,University of Texas Health Science Center at Houston (UTHealth), Houston, Texas; ^† Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School,UTHealth, Houston, Texas; and ^‡ Division of Critical Care Medicine, Department of Medicine, McGovern Medical School,UTHealth, Houston, Texas
^‡ Division of Critical Care Medicine, Department of Medicine, McGovern Medical School,UTHealth, Houston, Texas

Address correspondence to: Igor D. Gregoric, MD, 6400 Fannin, Suite 2350, Houston, TX 77030. E-mail: Igor.D.Gregoric@uth.tmc.edu

Received: 2 March 2021
Accepted: 31 May 2021

Abstract

Roux-en-y gastric bypass (RYGB) is one of the most common weight loss surgical procedures performed in the United States. Early post-operative small bowel obstruction is a rare but potentially morbid, complication of RYGB. We report two patients who underwent RYGB and required subsequent treatment for a post-operative small bowel obstruction. Their post-operative course was complicated by severe aspiration pneumonitis leading to hypoxemic respiratory failure requiring rescue with femoral veno-venous extracorporeal membrane oxygenation (V-V ECMO). Both patients were successfully extubated, weaned off V-V ECMO support, and discharged to home. These cases highlight the potential role of V-V ECMO for patients who have undergone RYGB and develop severe aspiration pneumonitis. They also highlight the need for cautionary use of gastrografin in RYGB patients. Early engagement of a multidisciplinary team experienced with adult ECMO is vital for favorable patient outcomes.