Afferent limb volvulus and perforation of the bypassed stomach as a complication of Roux-en-Y gastric bypass

A 35-year-old female who had previously undergone an open gastric bypass, underwent elective caesarian section and ventral hernia repair, complicated by a double closed-loop obstruction with resulting gastric perforation. Back pain and anemetic nausea predominated, as proximal bowel and pancreatobillary obstruction followed an afferent limb volvulus. Pancreatitis, cholangitis, and gastric perforation ensued, leading to intraabdominal sepsis. This rare situation must be recognized as a potentially serious complication of gastric bypass surgery, and requires prompt recognition and aggressive surgical correction.