Pregnant woman with fatal complication after laparoscopic Roux-en-Y gastric bypass

In Europe an increasing number of women have bariatric surgery. Therefore obstetricians are likely to encounter these patients. We report a 22 year old woman, who had previously undergone uncomplicated laparoscopic Roux-en-Y gastric bypass. She was admitted with severe abdominal pain at 35 weeks of gestation. A cesarean section with delivery of a healthy baby in combination with an exploratory laparotomy was performed. Internal herniation was suspected, but not identified during surgery. Three days later she died of a severely gangrenous small bowel secondary to internal herniation. This fatal case illustrates a potential complication and difficulties in the managment of pregnant women who have undergone Roux-en-Y gastric bypass. In these women observation and investigations based on multidisciplinary approach is vital if abdominal pain develops, with involvement of intestinal surgeons experienced in bariatric surgery as well as radiologists with specific knowledge of relevant imaging procedures.