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Reminder of important clinical lesson
CASE REPORT
Pregnant patient with acute abdominal pain and previous bariatric surgery
  1. Wouter KG Leclercq1,
  2. Martine Uittenbogaart1,
  3. Hendrik J Niemarkt2 and
  4. Judith OEH van Laar3
  1. 1 Surgery, Máxima Medical Center, Eindhoven and Veldhoven, The Netherlands
  2. 2 Neonatology, Máxima Medical Center, Eindhoven and Veldhoven, The Netherlands
  3. 3 Gynaecology, Máxima Medical Center, Eindhoven and Veldhoven, The Netherlands
  1. Correspondence to Wouter KG Leclercq, bariatrics.resurge{at}mmc.nl

Abstract

Pregnant women who previously had bariatric surgery may develop acute abdominal pain during pregnancy. Two patients, 38-year-old twin primigravida (gestational age of 24+6 weeks) and a 26-year-old woman (gestational age of 24+0 weeks), both of whom had laparoscopic gastric bypass surgery previously, developed abdominal pain. The patients both had diffuse abdominal pain in combination with normal blood tests and imaging. Patient B had undergone laparoscopy at another centre after 5 weeks of gestation for internal herniation. After referral to our multidisciplinary bariatric–obstetric–neonatal (MD-BON) team, diagnostic laparoscopy was advised as internal herniation was deemed possible. In both patients, internal herniation was indeed found in Petersen’s space and jejunal mesenteric defect, which was closed using laparoscopic surgery. Both women delivered healthy offspring afterwards. The presence of an MD-BON team allows for an increased awareness of potential long-term complications associated with earlier bariatric surgery in pregnancy.

  • gastrointestinal surgery
  • obstetrics, gynaecology and fertility
  • emergency medicine
  • obesity (nutrition)
  • neonatal health

https://doi.org/10.1136/bcr-2018-228962

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    Footnotes

    • Contributors Substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data: WKGL, MU. Drafting the work or revising it critically for important intellectual content: WKGL, MU, HJN, JOEHvL. Final approval of the version published: WKGL, MU, HJN, JOEHvL. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: WKGL, MU, HJN, JOEvHL.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Obtained.