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Emergency Department Management of Patients With Complications of Bariatric Surgery
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Publication Date: July 2019 (Volume 21, Number 7)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-A or 2-B CME credits. CME expires 07/01/2022.

Author

Adedamola Ogunniyi, MD
Associate Director, Residency Training Program, Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California; Assistant Professor, David Geffen School of Medicine at UCLA, Los Angeles, CA

Peer Reviewers

May Li, MD
Assistant Clinical Professor, Associate Director, Undergraduate Medical Education, NYU School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York, NY
 
Samuel D. Luber, MD, MPH, FACEP
Associate Professor, Vice-Chair of Education and Academic Affairs, Department of Emergency Medicine, Assistant Dean for Graduate Medical Education, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
 
Abstract
 
As bariatric procedures have become more common, more of these patients present to the emergency department postoperatively. The most common complaints in these patients are abdominal pain, nausea, and vomiting, though each of the surgical procedures will present with specific complications, and management will vary according to the surgical procedure performed. Computed tomography is often the primary imaging modality, though it has it limits, and plain film imaging is appropriate in some cases. This review presents an overview of the various bariatric procedures, highlighting the potential complications of each, both surgical and nonsurgical, and provides evidence-based recommendations regarding patient management and disposition.
 
Excerpt From This Issue

You are in the middle of a busy shift, during which you have seen several patients with abdominal pain, vomiting, and diarrhea. Your next patient is a 54-year-old woman who also presents for abdominal pain. She is 2 weeks out from a Roux-en-Y gastric bypass procedure and reports that her pain is diffuse and severe. She is ill-appearing, with vital signs notable for tachycardia, hypotension, and a low-grade fever. Her abdomen is diffusely tender and peritonitic. You immediately initiate resuscitation with IV fluids and broad-spectrum antibiotics and obtain laboratory studies and cultures. You have limited experience with such patients, but you realize that she will require advanced imaging to determine the diagnosis. You wonder what diagnostic tests to order and what treatment, if any, you should start…

You are later called to the bedside of another patient who presents for nausea and vomiting. He is a 38-year-old man who is 2 weeks out from the placement of a laparoscopic adjustable gastric band. He reports that he had an acute onset of nausea and vomiting this evening. He is actively vomiting on presentation and complains of diffuse abdominal pain, but is hemodynamically stable. While attempting to contact his surgeon, you wonder what the best imaging modality is to make the diagnosis….

 

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