Obesity is present in epidemic proportions in the United States, and bariatric surgery has become more common. Thus, emergency physicians will undoubtedly encounter many patients who have undergone one of these procedures. Knowledge of the anatomic changes specific to these procedures aids the clinician in understanding potential complications and devising an organized differential diagnosis. This article reviews common bariatric surgery procedures, their complications, and the approach to acute abdominal pain in these patients.
Key points
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In general, bariatric procedures achieve weight loss by altering gastrointestinal absorption, restricting gastric size, or a combination of both.
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In bariatric patients, abdominal pain may be caused by complications specific to their particular surgical procedure or by nonspecific complications, such as surgical site infection, cholelithiasis, bleeding, and small bowel obstruction.
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The differential diagnosis of abdominal pain in the patient who has had a Roux-en-Y gastric bypass or a biliary pancreatic diversion includes anastomotic leak or stenosis, dumping syndrome, gastric remnant dilatation, stomal ulcer, and internal or incisional hernia.
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Following laparoscopic adjustable gastric banding, abdominal pain may be caused by esophagitis, hiatal hernia, gastroesophageal dilatation, band erosion, band slippage, gastric prolapse, stomal obstruction, or port infection.
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Patients who have had a sleeve gastrectomy may suffer from gastric leak, gastric stenosis, or gastroesophageal reflux.
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