Background
Bariatric surgery is increasingly common in Australia as nearly two-thirds of Australian adults are overweight or obese. This case reports a pregnant lady with unusual presentation of back pain who was found to have ischemic bowel on background of bariatric surgery.
Case
JM, a 42 year old woman presented with severe back pain, abdominal pain, diarrhoea and vomiting at 16 weeks gestation on background history of Roux-en-Y gastric bypass and abdominoplasty. A laparotomy was done for partial resection of ischemic bowel, secondary to an internal hernia involving the Roux limb of the Roux-en-Y bypass. Post-operative course was complicated by deranged liver function and bilateral pitting oedema. JM had an elective caesarean at 38 weeks gestation; a healthy 2.74kg baby boy was born. She then developed a large ventral incisional hernia from recent midline laparotomy. She was commenced on Creon, doxycycline and probiotics with regular dietician review. JM had a steady recovery and a well baby.
Discussion
Obesity increases the rate of early pregnancy loss, hypertension, preterm labour, type 2 diabetes and gestational diabetes. Bariatric surgery reduces the rate of these obesity-related pregnancy complications as well as increasing fertility. Bariatric surgery is however associated with an increased risk of intrauterine foetal growth restriction and surgical complications during pregnancy. Given the increased prevalence of pregnant women with history of bariatric surgery, it is crucial to be able to recognise complication of bariatric surgery in pregnancy and treat these women promptly.