Urgent Care Management of the Patient With Prior Bariatric Surgery

August 2026 Postscript #1

Test Your Knowledge

A 41-year-old woman presents with intermittent, crampy abdominal pain, nausea, and decreased oral intake that began earlier that morning. She reports the pain comes in waves and occasionally radiates to her back. She underwent a Roux-en-Y gastric bypass (RYGB) 18 months ago. Her temperature is 37.1°C, heart rate is 114 beats/min, and blood pressure is 128/76 mm Hg. Abdominal examination reveals only mild diffuse tenderness without guarding or rebound.

Which of the following is the most appropriate next step?

1. Prescribe ondansetron and discharge with return precautions
2. Order an abdominal radiograph and discharge if normal
3. Prompt referral to the emergency department for computed tomography (CT) and bariatric surgical consultation
4. Start a proton-pump inhibitor and arrange outpatient gastroenterology follow-up