Management of an extremely severe internal herniation in a 39-week pregnant female with a history of Roux-en-Y gastric bypass resulting in short bowel syndrome: a case report.

Abstract Internal herniation (IH) is a common but potentially fatal complication (up to 10%) of gastric bypass which is often lately or misdiagnosed during pregnancy. While in non-pregnant bariatric patients, nausea, vomiting, and abdominal pain are red flags, these symptoms are frequently reported in normal pregnancies, therefore leading to serious treatment delays and possible life-threatening complications. Intestinal obstruction and volvulus can lead to necrosis and perforation within 8-16 hours. Previous reviews report higher risk of maternal (9%) and fetal (13.6%) death when diagnosis is delayed over 48 hours. The lack of clear clinical or laboratory findings and the reticence for radiologic imaging techniques during pregnancy delays diagnosis even more. If bowel necrosis is extended, bowel resection may be indicated, possibly leading to short bowel syndrome for life. Here, a rare case of short bowel syndrome is presented, requiring home parenteral nutrition (HPN) after extremely severe internal hernia at 39 weeks of pregnancy and several practical challenges encountered in the recognition and management of IH during pregnancy.