Small bowel obstruction after gastric by-pass: Diagnostic limits and percutaneous drain. A paradigmatic case

BACKGROUND: Obesity is showing a constant increase worldwide, making it the major public health problem. Bariatric surgery seems to be the best treatment for these to achieve a good excess weight loss. Gastric by-pass (GBP) is one the most important bariatric procedure, but there are a lot of complications as bowel obstruction for internal hernia, fistula and intussusception. CASE REPORT: We present a peculiar case report of a 53-years old woman that underwent to GBP. On the fourth postoperative day, she presented a bowel obstruction and underwent a second surgical intervention for incisional hernia. Another surgical revision was necessary because of dilatation of excluded stomach. Subsequent external drain of excluded stomach solved the paralytic ileum post bowel obstruction. CONCLUSION: Postoperative occlusion is more complex in bariatric patients, either for variety of etiology, either for choosing best approach to the new anatomy. In addition, post-surgery course may be different, because GBP may determine many modifications on gastrointestinal motility and clinical symptoms. An accurate knowledge of bariatric surgery is mandatory in these situations, obtaining the best management.