Gastric Bypass Surgery Causes Bowel Ischemia

This case takes place in Maryland and involves a male patient who underwent a laparoscopic gastric bypass performed by the defendant. The operative note appears to be without incident and no complications were noted. Post-operatively, the patient complained of severe abdominal pain after taking pain medications. The surgeon on call was notified and she was given additional pain medications, but the patient continued to complain of elevated pain throughout the night. The surgeon on call was again notified and additional pain medications were ordered. The next morning, the defendant requested imaging of the patient’s abdomen be performed, at which point a bowel obstruction was identified. The Defendant returned the patient to the operating room, where he was diagnosed with an ischemic bowel. The surgeon documented that patient had an extremely short small intestine. The patient continues to suffer from intra-abdominal infections and has experienced a severely diminished quality of life.

Question(s) For Expert Witness

1. Do you have extensive experience performing Roux-en-Y gastric bypass surgery?

2. What steps should be taken after patient complains of extreme pain and hypertension post surgery?

3. Are you familiar with the necessary steps when patient complains of the above symptoms?

Expert Witness Response E-001161

I am a fellowship-trained bariatric surgeon, and I regularly perform Roux-en-Y gastric bypass surgery. This patient's BMI is not very high, which makes this complication more unfortunate, and less comprehensible. Likely, there either was an intra-operative complication such as inappropriate twisting of bowel, or pre/post-operative complication such as inappropriate anticoagulation. Pain in the setting of hypertension should be carefully examined, and appropriate imaging studies as well as laboratory evaluations are necessary to determine the cause of the pain. We are a tertiary center and we do take care of patients with similar issues from other institutions.