Small bowel obstruction secondary to intraluminal bleeding after Roux-en-Y gastric bypass

Small bowel obstruction (SBO) is a known complication of Roux-en-Y gastric bypass (RYGB) but rarely results from intraluminal bleeding (ILB) and hemobezoar formation. ILB-related SBO usually occurs in the first 72 h after surgery and may be potentiated by prophylactic anticoagulation or non-steroidal anti-inflammatory drugs. We present the case of a 41-year-old female with prior sleeve gastrectomy who underwent robotic-assisted RYGB and developed early post-operative abdominal pain, distention and tachycardia. Computed tomography demonstrated SBO with hyperdense intraluminal contents distal to the jejunojejunostomy. Emergency re-exploration revealed a consolidated haematoma obstructing the bowel lumen, managed successfully with enterotomy and clot evacuation; anastomotic revision was unnecessary. Post-operative recovery was complicated by an intra-abdominal abscess, managed percutaneously. This rare case highlights the importance of early recognition of ILB as a cause of SBO, prompt imaging and timely surgical management to prevent ischaemia or perforation or anastomotic dehiscence.