title: Internal hernias in pregnant women with history of gastric bypass surgery: Case series and review of literature.
abstract: BACKGROUND
  Gastric bypass surgery is the most common obesity surgery procedure in women. Decreased weight loss favors fertility and leads to pregnancy sometimes just months after surgery, raising the risk of developing gastric bypass-related complications during pregnancy, including the formation of internal hernias.
  
  
  METHODS
  The first patient presented at 37 weeks of gestation with abdominal pain, nausea and vomiting. X-ray revealed multiple air-fluid levels and absence of gas in colon. She underwent a cesarean section and exploratory laparotomy without complications. A Petersen's space internal hernia was found. The second patient presented at 25 weeks of gestation with abdominal pain and nausea. X-ray revealed multiple air-fluid levels and a "U-shaped" intestinal loop. She underwent exploratory laparotomy with reduction of an internal hernia also in Petersen's space.
  
  
  CONCLUSIONS
  Pregnant patients with internal hernias after gastric bypass are usually of young age and with a several-day history of abdominal pain. Surgical exploration is safe and should not be delayed. The literature review showed that maternal death (9%) and fetal death (13.6%) rates are considerably high.
  
  
  CONCLUSIONS
  The possibility of an internal hernia should always be considered in pregnant women with history of gastric bypass who present with abdominal pain, in order to prevent catastrophic outcomes such as maternal and/or fetal death.
authors.affiliation: Tecnológico de Monterrey, School of Medicine and Health Sciences, Mexico. Electronic address: raul.leal@usa.net.
authors.forename: Raúl
authors.initials: R
authors.lastname: Leal-González
authors.forename: Rafael
authors.initials: R
authors.lastname: De la Garza-Ramos
authors.forename: Horacio
authors.initials: H
authors.lastname: Guajardo-Pérez
authors.forename: Fernando
authors.initials: F
authors.lastname: Ayala-Aguilera
authors.forename: Roberto
authors.initials: R
authors.lastname: Rumbaut