Internal hernia in pregnancy after Roux-en-Y gastric bypass: A surgical diagnostic dilemma

Abstract

Rationale: Internal hernia after Roux-en-Y gastric bypass (RYGB) is a lifelong risk. During pregnancy, this risk increases due to the rise in the intra-abdominal pressure. Early recognition and intervention are the keys to have a better outcome. The aim of this case report is to shed the light on the possibility of such occurrence. Patient Concerns: A 40-year-old woman presented to the emergency department at 36 weeks of gestation with acute abdominal pain. Diagnosis: She was in labor. In view of her past history of gastric bypass, a surgical consult was obtained. Patient developed episodes of hypotension with deceleration, so an emergency caesarean section was performed. Interventions: The abdomen was explored Intraoperatively. An internal hernia with small bowel volvulus was found. Outcomes: The hernia reduced and bowel revived. Postoperatively, the patient had a smooth recovery and a healthy baby. Lessons: Nowadays, due to the global obesity epidemic, lots of women of childbearing age are undergoing bariatric surgery all over the world. Having the knowledge about the possible complications of such procedures is of paramount importance. This is in order to be able to have an earlier operative intervention whenever indicated, hence, decreasing the maternofetal morbidity and mortality. Internal herniation after RYGB exemplifies a rare, high-risk complication that might occur in pregnancy. A high index of suspicion is required for early diagnosis and better outcome.