We report a rare case of a small bowel obstruction secondary to a volvulus of a side-to-side jejunoileal anastomosis for bariatric surgery. Between 1960 and 1980, when jejunoileal bypass surgery was common, the mainstay of delayed complications was related to malabsorption of vitamins, hepatic disease and nephrolithiasis [
3]. Small bowel obstruction secondary to jejunoileal bypass surgery has been reported but this is usually functional or secondary to adhesions [
4,
5]. Our case is rare because the volvulus was secondary to the fashioning of a narrow side-to-side anastomosis at initial surgery, whereas all other reported cases have been as a result of a volvulus of an end-to-end or side-to-end anastomosis [
5,
6]. As in our case, the clinical presentation of a small bowel obstruction following jejunoileal bypass surgery is usually non-specific and is delayed usually by 18 to 60 months [
5,
6]. As seen in our case, the delay in presentation after the initial surgery can result in diagnostic difficulty. The inherent difficulty in the clinical cause of small bowel obstruction places a great onus on imaging to determine a diagnosis. The literature reports 71% to 92% specificity and 71% to 94% sensitivity of CT scanning in the diagnosis of small bowel obstruction [
7,
8]. In closed loop obstruction, the specificity falls to 78% [
9]. In our case there was a delay in diagnosis due to intermittency of symptoms. A CT scan provided a diagnosis which was subsequently definitively made with an oral contrast swallow study. The importance of early imaging in such cases is crucial in instituting appropriate management. The placement of a proximal jejunal band is uncommon in typical jejunoileal bypass procedures. There are isolated case reports of band-related bowel obstruction; however these are a result of intraluminal band obstruction following erosion of the gastric band [
10,
11]. Our case is interesting as our findings showed that the jejunal band had migrated into the small bowel mesentery. We describe an effective operating technique for the management of a volvulus secondary to a narrow side to side jejunoileal anastomosis. The fixation of the apex of the volvulus, by approximation of the adjacent bowel proximal and distal to the anastomosis avoided the need to re-fashion the anastomosis. The laparoscopic surgical options in our case were extremely limited by the emergency presentation as well as the previous open surgery. Adhesions post open-abdominal surgeries are well reported [
12,
13]. They are associated with increased complications and re-hospitalization rates, making laparoscopic intervention difficult in an emergency setting [
14]. If such contraindications are not present our technique is quite amenable to a laparoscopic approach. Our case raises several important dilemmas with regard to health tourism. Jejunoileal bypass surgery for bariatric patients has fallen out of favor in European and North American surgical centers due to poor long term outcomes and delayed complications [
3,
15]. As a result the complications are not commonly encountered and make diagnosis and management difficult. In addition, the surgical center was on another continent making communication and notes requesting challenging. We suggest that perhaps patients who undergo similar complex operations should be advised or provided with a detailed summary of their initial procedure if travelling abroad.