• Samia Farooqi, Timothy Montrief, Alex Koyfman, and Brit Long.
• Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA.
• Am J Emerg Med. 2024 Nov 2; 87: 113122113-122.

IntroductionBariatric surgery complications carry a high rate of morbidity and mortality.ObjectiveThis review highlights the pearls and pitfalls of bariatric surgery complications, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence.DiscussionBariatric surgeries include restrictive procedures (e.g., adjustable gastric banding, endoscopic gastric balloon insertion, and sleeve gastrectomy) and mixed restrictive and malabsorptive procedures (e.g., roux-en-y gastric bypass and duodenal switch-biliopancreatic diversion). Several complications may occur, which may be associated with severe morbidity and mortality. These complications include anastomotic/staple line leaks, small bowel obstruction and internal hernia, marginal ulceration, biliary disease, and device-specific issues. History concerning the type of surgery, when and where it was performed, prior complications, changes in weight, and systemic symptoms is essential. Many signs and symptoms are subtle, but fever, tachycardia, and persistent vomiting are concerning for a severe complication. If there is concern for a complication, emergent consultation with the bariatric surgeon is recommended (preferably the patient's surgeon). Imaging studies can assist in the evaluation, including computed tomography with oral and intravenous contrast. Resuscitation in the ED and early intervention by a bariatric surgeon provide the best opportunity to reduce morbidity and mortality for patients with intra-abdominal pathology.ConclusionUnderstanding bariatric surgery complications can assist emergency clinicians in diagnosing and managing this potentially deadly disease.Published by Elsevier Inc.

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