Barium Granulomatosis: A Rare Cause of Obstruction after Remote Bariatric Surgery and a Cautionary Tale of Contrast Selection with Surgical and Pathologic Correlation

Bariatric weight loss procedures have dramatically increased in recent years, but are not without significant complications, including post-procedural leakage. Upper gastrointestinal examination (UGI) studies or computed tomography (CT) abdomen with oral contrast, in conjunction with clinical suspicion, have ex-cellent specificity for detection of leaks; however, attention to the contrast agent can be crucial to avoid worsening the patient’s clinical outcome. We present a 64-year-old male with a previous adjustable gastric band (AGB) converted to a laparoscopic sleeve gastrectomy who was evaluated with barium UGI study in the post-operative period. Years later, the patient presented to the emergency room with acute small bowel obstruction (SBO), secondary to barium granulomatosis, and required extensive small bowel resection hemicolectomy and anastomosis. In addition to this novel complication, this case highlights the importance of appro-priate contrast media selection and treatment options should this complication arise.