title: Case review and consideration for imaging and work evaluation of the pregnant bariatric patient.
abstract: BACKGROUND
  There is an increasing trend toward morbid obesity in women of childbearing age and a subsequent increase in number of weight reduction surgeries in these individuals. As a result, special attention needs to be paid to potential postsurgical complications during pregnancy, particularly after Roux-en-Y gastric bypass (RYGB). We are presenting our small case series and our suggestions for management for the pregnant bariatric patient. The aim of this study is to review our institutional experience and present our algorithm to approach pregnant women presenting with abdominal pain and/or emesis after RYGB.
  
  
  METHODS
  After Institutional Review Board approval, a retrospective chart review was performed at a single center institution between 2010 and 2013. Data regarding clinical presentation, physical exam findings, laboratory values, radiographic studies, intraoperative findings, and clinical outcomes of both mother and fetus were collected and reviewed for pregnant patients with history of RYGB and abdominal distress.
  
  
  RESULTS
  Five patients were identified. Patient age ranged from 22-34 years (mean 28.4). Gestational age ranged from 9-31 months (mean 19.2). Average body mass index at presentation was 30.3 kg/m(2). Of the 5 patients, 4 presented with abdominal pain and one with intractable emesis. Four patients were taken to the operating room. One was successfully discharged. Two of the patients had an obstruction from adhesions, and the other 2 were found to have internal hernia. There was no mortality for either fetus or mother. One patient required premature delivery at 28 weeks.
  
  
  CONCLUSIONS
  Pregnant women with history of RYGB who present with abdominal pain should be evaluated urgently for internal hernia or obstruction. A systematic approach is needed to ensure prompt diagnosis.
authors.affiliation: Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center. Stony Brook, New York. Electronic address: Maria.Altieri@stonybrookmedicine.edu.
authors.forename: Maria S
authors.initials: MS
authors.lastname: Altieri
authors.affiliation: Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center. Stony Brook, New York.
authors.forename: Dana A
authors.initials: DA
authors.lastname: Telem
authors.affiliation: Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center. Stony Brook, New York.
authors.forename: Pamela
authors.initials: P
authors.lastname: Kim
authors.affiliation: Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center. Stony Brook, New York.
authors.forename: Gerald
authors.initials: G
authors.lastname: Gracia
authors.affiliation: Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center. Stony Brook, New York.
authors.forename: Aurora D
authors.initials: AD
authors.lastname: Pryor
mesh_terms: D000328:Adult; D050110:Bariatric Surgery; D015992:Body Mass Index; D003657:Decision Making; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D005865:Gestational Age; D006801:Humans; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D011247:Pregnancy; D011248:Pregnancy Complications; D012189:Retrospective Studies; D055815:Young Adult
keywords: Bariatric surgery; Complications; Pregnancy; Roux-en-Y gastric bypass