Skip to main content
SpringerLink
Log in

Gastrointestinal Bleeding in the Bariatric Patient: What Else Should I Consider?

  • Chapter
  • First Online:
Gastrointestinal Emergencies

  • 96 Accesses

Abstract

This chapter briefly reviews the unique causes of gastrointestinal bleeding in bariatric patients who have undergone Roux-en-Y gastric bypass, gastric banding, or sleeve gastrectomy. For all bariatric patients in the early postoperative period, iatrogenic bleeding is of immediate concern. For gastric bypass and sleeve gastrectomy patients, staple line bleeding may occur in the early postoperative period. In the late postoperative period (>30 days from procedure), clinicians should consider marginal ulcers and band erosion for gastric bypass and gastric band patients, respectively. Evaluation of these patients may include radiologic studies, typically in conjunction with endoscopy. Management ranges from proton pump inhibitor (PPI) therapy to emergent surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Bellorin O, Abdemur A, Sucandy I, Rosenthal R. Understanding the significance, reasons and patterns of abnormal vital signs after gastric bypass for morbid obesity. – PubMed – NCBI [Internet]. Ncbi.nlm.nih.gov. 2018 [cited 12 Jan 2018]. Available from: https://www.ncbi.nlm.nih.gov/m/pubmed/20582574/.

  2. Fridman A, Szomstein S, Rosenthal RJ. Postoperative bleeding in the bariatric surgery patient. In: Nguyen N, Blackstone R, Morton J, Ponce J, Rosenthal R, editors. The ASMBS textbook of bariatric surgery. New York: Springer; 2015.

    Google Scholar 

  3. Rabl C, Peeva S, Prado K, James A, Rogers S, Posselt A, et al. Early and late abdominal bleeding after roux-en-Y gastric bypass: sources and tailored therapeutic strategies. Obes Surg. 2011;21(4):413–20.

    Article  Google Scholar 

  4. Gumbs A, Duffy A, Bell R. Incidence and management of marginal ulceration after laparoscopic roux-Y gastric bypass. Surg Obes Relat Dis. 2006;2(4):460–3.

    Article  Google Scholar 

  5. Puri V, Alagappan A, Rubin M, Merola S. Management of bleeding from gastric remnant after roux-en-Y gastric bypass. Surg Obes Relat Dis. 2012;8(1):e3–5.

    Article  Google Scholar 

  6. Miao T, Kielar A, Patlas M, Riordon M, Chong S, Robins J, et al. Cross-sectional imaging, with surgical correlation, of patients presenting with complications after remote bariatric surgery without bowel obstruction. Abdom Imaging. 2015;40(8):2945–65.

    Article  Google Scholar 

  7. Sidani S, Akkary E, Bell R. Catastrophic bleeding from a marginal ulcer after gastric bypass. J Soc of Laparoendosc Surg. 2013;17(1):148–51.

    Article  Google Scholar 

  8. Kothari S. Bariatric surgery and postoperative imaging. Surg Clin N Am. 2011;91(1):155–72.

    Article  Google Scholar 

  9. Guniganti P, Bradenham C, Raptis C, Menias C, Mellnick V. CT of gastric emergencies. Radiographics. 2015;35(7):1909–21.

    Article  Google Scholar 

  10. Issa H, Al-Saif O, Al-Momen S, Bseiso B, Al-Salem A. Bleeding duodenal ulcer after roux-en-Y gastric bypass surgery: the value of laparoscopic gastroduodenoscopy. Ann Saudi Med. 2010;30(1):67–9.

    Article  Google Scholar 

  11. Nguyen N, Wilson S. Complications of anti obesity surgery. Nat Clin Pract Gastroenterol Hepatol. 2007;4(3):138–47.

    Article  Google Scholar 

  12. Heneghan H, Meron-Eldar S, Yenumula P, Rogula T, Brethauer S, Schauer P. Incidence and management of bleeding complications after gastric bypass surgery in the morbidly obese. Surg Obes Relat Dis. 2012;8(6):729–35.

    Article  Google Scholar 

  13. Ellsmere J, Jones D, Chen W. Late complications of bariatric surgical operations [Internet]. Uptodate.com. 2017 [cited 12 Jan 2018]. Available from: https://www.uptodate.com/contents/late-complications-of-bariatric-surgical-operations.

  14. Lewis K, Takenaka K, Luber S. Acute abdominal pain in the bariatric surgery patient. Emerg Med Clin North Am. 2016;34(2):387–407.

    Article  Google Scholar 

  15. Schulman AR, Abougergi MS, Thompson CC. H. Pylori as a predictor of marginal ulceration: a nationwide analysis. Obesity. 2017;25(3):522–6.

    Article  Google Scholar 

  16. Rawlins L, Rawlins MP, Brown CC, Schumacher DL. Effect on helicobacter pylori on marginal ulcer and stomal stenosis after roux-en-Y gastric bypass. Surg Obes Relat Dis. 2013;9(5):760–4.

    Article  Google Scholar 

  17. Papasavas PK, Gagne DJ, Donnelly PE, Salgada J, Urbandt JE, Burton KK, Caushaj PF. Prevalence of helicobacter pylori infection and value of preoperative testing and treatment in patients undergoing laparoscopic roux-en-Y gastric bypass. Surg Obes Relat Dis. 2008;4(3):383–8.

    Article  Google Scholar 

  18. Cappell M, Mogrovejo E, Desai T. Case report of patient presenting in shock from band penetration into stomach after LAGB surgery: diagnosis by emergency EGD after misdiagnosis by abdominal CT. Dig Dis Sci. 2016;61(11):3366–8.

    Article  Google Scholar 

  19. Lehnert B, Moshiri M, Osman S, Khandelwal S, Elojeimy S, Bhargava P, et al. Imaging of complications of common bariatric surgical procedures. Radiol Clin N Am. 2014;52(5):1071–86.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, DC, USA

    Christina S. Houser

  2. Canton-Potsdam Hospital, Potsdam, NY, USA

    Julie T. Vieth

Authors
  1. Christina S. Houser
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Julie T. Vieth
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christina S. Houser .

Editor information

Editors and Affiliations

  1. Department of Emergency Medicine, MedStar Georgetown University Hospital, Washington, DC, USA

    Autumn Graham

  2. Department of Emergency Medicine, MedStar Georgetown University Hospital, Washington, DC, USA

    David J. Carlberg

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Houser, C.S., Vieth, J.T. (2019). Gastrointestinal Bleeding in the Bariatric Patient: What Else Should I Consider?. In: Graham, A., Carlberg, D.J. (eds) Gastrointestinal Emergencies. Springer, Cham. https://doi.org/10.1007/978-3-319-98343-1_124

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-98343-1_124

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-98342-4

  • Online ISBN: 978-3-319-98343-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation