Fatal complications after an interrupted gastric bypass operation in a patient with non-alcoholic fatty liver disease and massive obesity: a case report

Obesity is closely linked to non-alcoholic fatty liver disease and non-alcoholic steatohepatitis (NASH), the latter now being the most common cause of cirrhosis in Western countries. Only a few cases have been described, such as the unexpected death after interrupted obesity surgery in a patient due to inaccurate preoperative imaging assessment. We describe a 53-year-old male patient with multiple comorbidities partly related to his obesity. A laparoscopic Roux-en-Y gastric bypass (LRYGB) was attempted. During anaesthesia, the patient had a cardiac arrhythmia and a short asystole. Intra-operative findings indicated a giant spleen and, unexpectedly, a cirrhotic liver. The LRYGB operation was interrupted. After 19 months, the patient died due to his severe comorbidities. Preoperative imaging missed the diagnosis of liver cirrhosis and related NASH. Since a challenging liver failure diagnosis cannot only rely on current imaging, we suggest that a liver biopsy is performed prior to LRYGB if preoperative imaging indicates cirrhotic liver.