Pregnancy after gastric bypass surgery and internal hernia formation.
BACKGROUND
Gastric bypass is a surgical procedure that is increasingly performed in the United States to treat morbid obesity. Because of the changes associated with pregnancy, women with a history of gastric bypass surgery may be at an increased risk of gastrointestinal complications during the antepartum period, as demonstrated by these cases.


METHODS
The first patient presented at 12 weeks of gestation with abdominal pain. Computed tomography scan revealed rotation of the small bowel mesentery. In the operating room, a Petersen's internal hernia was observed. The second patient presented at 34 weeks of gestation with epigastric pain, nausea, and vomiting. An abdominal computed tomography scan suggested distention of the biliopancreatic limb, duodenum, and bypassed stomach. She underwent exploratory laparotomy with repair of an internal (mesenteric loop) hernia.


CONCLUSIONS
As obstetricians, we should be aware of the potential for internal hernias in pregnant patients who have undergone bariatric surgery.
Kakarla
Nirupama
N
Divisions of General Obstetrics and Gynecology and Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tufts-New England Medical Center, Boston, Massachusetts, USA. nkakarla@bcm.tmc.edu
Dailey
Christine
C
Marino
Teresa
T
Shikora
Scott A
SA
Chelmow
David
D
D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology; D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D005865:Gestational Age; D046449:Hernia, Abdominal / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007813:Laparotomy / Q000379:methods; D008423:Maternal Age; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000601:surgery*; D011256:Pregnancy Outcome; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal