E1285. Trimming the Fat: A Cased Based Review of Bariatric Surgery Complications
  1. Mary Hargis; Naval Medical Center San DIego
  2. Jennifer Foley; Naval Medical Center San DIego
  3. Richard Montgomery; Naval Medical Center San DIego
Obesity has steadily been on the rise in the United States from 2011 to 2018 according to the Center for Disease Control Behavioral Risk Factor Surveillance System (1). In 2018 it is estimated that approximately 30.9% of adults over the age of 18 in America are obese (2). A popular choice for treatment is bariatric surgery, with over 575,000 procedures being recorded in the IFSO database in 2014 (3). The most common bariatric surgeries worldwide are Roux en Y and sleeve gastrectomy (4). Though bariatric surgery has been shown effective in weight loss, it can also result in both nutritional and gastrointestinal complications (5,6).

Educational Goals / Teaching Points
The objective of this exhibit is to display a radiographic review of a range of bariatric surgery techniques, normal post-surgical anatomy and imaging presentation of complications. Though the goal in all procedures is to utilize similar physiology for weight loss, the techniques vary widely. As such, the potential complications are unique and require understanding of normal anatomy.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
-In surgeries that use implanted devices such as an intragastic balloon and the gastric band, positioning is critical for weight loss and preventing gastric obstruction. -Bowel positioning in Roux en Y gastric bypass on CT can help identify impending obstruction secondary to herniation. -Location and anastomoses involving the limbs of Roux en Y gastric bypass give rise to unique complications.

Having familiarity with the breadth of gastrointestinal surgical options is essential in diagnostic imaging. Altered anatomy can predispose to complications related to fistula/stricture development, abnormal mesenteric configuration and device migration, among others. Pathology may present in an unusual fashion or be more difficult to evaluate and treat endoscopically, so imaging can be key to diagnosis. Complications can develop years after surgery, so suspicion should remain high.