Complications from Roux-en-Y gastric bypass mistaken for medical complications in gravid patients.

Background: The increased frequency of bariatric surgery has resulted in a growing number of intrapartum surgical emergencies including internal hernia, bowel obstruction, and gastric rupture.

Case: We describe the cases of three gravid women with history of laparoscopic Roux-en-Y gastric bypass surgery who experienced significant complications during subsequent pregnancy. Two patients became hemodynamically unstable and required emergent laparotomy. In both cases, fetal outcomes were poor but the patients ultimately recovered after prolonged hospital courses. In the third patient, early recognition allowed for a minimally invasive surgical correction.

Conclusion: After bariatric surgery, patients who become pregnant are at risk for serious postoperative complications. Because symptoms can be subtle, a high index of suspicion and early intervention by a multidisciplinary team is necessary to prevent catastrophic outcomes.