E2150. Bariatric Surgery Gone Bad: Multimodality Imaging of Expected Findings and Complications Encountered in the Emergency Department
  1. Ahmed Sobieh; University of Kentucky
  2. Trae Brooks; University of Kentucky
  3. Emory Wilds ; University of Kentucky
  4. Josh Steiner; University of Kentucky
  5. James Lee; University of Kentucky
As the rate of obesity continues to rise in the world, so does the rate of bariatric surgeries. In the United States from 2011 to 2018, nearly 100,000 cases of bariatric surgeries were performed. Although complications are rare, they can be particularly serious in this patient population. Complications related to bariatric surgery may happen in the immediate perioperative period or many months or years later. Knowledge of common bariatric procedures, the normal postoperative appearance, and the imaging findings related to complications is necessary for radiologists working in the emergency department so they can identify signs of potential catastrophic complications. The purpose of this exhibit is to review these procedures, their associated anatomy on multimodality imaging, and postsurgical complications.

Educational Goals / Teaching Points
Form an introductory knowledge base of common bariatric surgical procedures and their associated normal imaging findings. Gain an understanding of potential postsurgical complications of bariatric procedures. Review imaging findings associated with postsurgical complications from bariatric surgery on multiple modalities.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The Peterson space hernia is an internal hernia that can happen in a surgically created potential space posterior to the roux limb of RGB. Small bowel herniates through the defect between small bowel limbs, transverse mesocolon, and  retroperitoneum especially after a laparoscopic approach. Anastomotic leak represents one of the most serious complications in the perioperative period, with incidence up to 6% and carries a relatively high mortality and morbidity rate. Most complications arise from the gastro-jejunal anastomosis; however, they can also occur from gastric pouch, jejunal stump, and, rarely, from the jejuno-jejunal (J-J) anastomosis. J-J intussusception occurs when  a bowel segment is pulled on itself and into an adjacent loop which may occur at the J-J anastomosis. Although often observed as a transient and incidental finding, on rare occasion a J-J intussusception may represent a serious complication. Marginal ulcers result from prolonged exposure of jejunal mucosa to gastric secretions.  They may result in  gastro-jejunal anastomotic strictures and occasionally perforation.

In summary, the spectrum of possible complications related to common bariatric surgical procedures is broad, and patients coming to the emergency department may have a nonspecific clinical presentation. Radiologists can play a key role in the evaluation of these patients, and it is therefore imperative that radiologists working in the emergency fepartment are familiar with the imaging of these procedures as well as their potential complications.