San Francisco Injury Lawyer Blog

I just finished a wrongful death case where a 30 year old woman died of one severe complication of gastric bypass surgery. She experienced what is termed an internal hernia, where the small intestine migrates through a hole intentionally made by most surgeons performing a Roux enY procedure using a laparoscope. There are many complications of gastric bypass surgery including gallstones, leakage of stomach contents into abdomen, nutritional deficiencies and more. See WebMD.
Internal hernia is not an uncommon complication of gastric bypass. It can be difficult to diagnose and disastrous if it remains undiagnosed. The danger is that the migrated intestine can twist on itself much like a garden hose can kink and cut off blood flow leading to inadequate or no blood flow and death of tissue. The hernia with migration of intestine is not necessarily acutely painful if it has not twisted on itself. One may simply feel generalized discomfort and abdominal pain that is not severe. The pain and associated problems can wax and wane because the intestine may migrate back through the hole to return to its original position. A patient may experience diarrhea and/or nausea or vomiting and be unable to eat. In some cases this can be confused with dumping syndrome by the treating physician. Often the pain is upper abdominal because the mesocolon hole that is made during surgery is in that location, above the umbilicus (belly button). The best test to diagnose the internal hernia is the CT scan, although a negative CT will not rule out the problem.

If portions of the 25 or more foot long intestine migrate through the hole in the mesocolon made by the laparoscope, sometimes the intestine can be trapped in the hole--it can get in but is unable to get out. If incarceration or twisting occurs the patient will likely experience severe pain requiring immediate treatment, probably to include surgery. Sometimes the symptoms can include those early symptoms of sepsis, either low or high temperatures, an increased respiration rate and/or increased heart rate. Careful monitoring of a patient with this complication in the differential diagnosis is essential and care must be taken to insure the patient does not descend into septic shock.

Actually, any patient with suspected internal hernia should have that complication ruled in or out without delay. Timing can be a life or death decision since no one knows when the migrated intestine can become twisted, incarcerated and ischemic.