Today’s pearl was inspired by Vincent Roddy
A 38-year-old man presents to the emergency department 6 weeks after Roux-en-Y gastric bypass with recurrent abdominal pain, nausea, and bilious vomiting. He has had 3 total episodes during the past month, with each episode being more severe than the last. He describes the pain as a crampy, periumbilical pain relieved after vomiting undigested food and bilious fluid. What is the most likely diagnosis?
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Answer: Internal hernia, which can occur anytime after a bariatric surgery. Internal hernias occur more commonly after laparoscopic procedures given there are fewer postoperative adhesions, and therefore the bowel is more mobile and able to slide into mesenteric defects. If clinical suspicion is high, surgery must be consulted regardless of CT results.
