Obstruction

This is less common than bowel redundancy and strictures, with 5.6% of Burgos et al.’s cohort (183) reporting one or more incidents. Aetiology is very variable and dependant on the anatomy of the patients and their grafts, and includes volvulus and diaphragmatic hernia, and is more common in those with redundancy in the interposition. (76) Symptoms are as for other complications of these conduits, listed above, but with an acute onset of symptoms and rapidly progressive weight loss. This is a medical emergency, and again is best dealt with in a tertiary centre with prior knowledge of the patient. The obstruction is usually managed conservatively, with non-surgical decompression, parenteral nutrition and IV fluids, but surgical management is needed in some cases. This can be a recurrent phenomenon in some patients.