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

  • Christina S. HouserEmail author
  • Julie T. Vieth


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.


Bariatric surgery Gastrointestinal bleeding Roux-en-Y gastric bypass Sleeve gastrectomy Gastric band Marginal ulcer Band erosion 


  1. 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]. 2018 [cited 12 Jan 2018]. Available from:
  2. 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. 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.CrossRefGoogle Scholar
  4. 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.CrossRefGoogle Scholar
  5. 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.CrossRefGoogle Scholar
  6. 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.CrossRefGoogle Scholar
  7. 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.CrossRefGoogle Scholar
  8. 8.
    Kothari S. Bariatric surgery and postoperative imaging. Surg Clin N Am. 2011;91(1):155–72.CrossRefGoogle Scholar
  9. 9.
    Guniganti P, Bradenham C, Raptis C, Menias C, Mellnick V. CT of gastric emergencies. Radiographics. 2015;35(7):1909–21.CrossRefGoogle Scholar
  10. 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.CrossRefGoogle Scholar
  11. 11.
    Nguyen N, Wilson S. Complications of anti obesity surgery. Nat Clin Pract Gastroenterol Hepatol. 2007;4(3):138–47.CrossRefGoogle Scholar
  12. 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.CrossRefGoogle Scholar
  13. 13.
    Ellsmere J, Jones D, Chen W. Late complications of bariatric surgical operations [Internet]. 2017 [cited 12 Jan 2018]. Available from:
  14. 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.CrossRefGoogle Scholar
  15. 15.
    Schulman AR, Abougergi MS, Thompson CC. H. Pylori as a predictor of marginal ulceration: a nationwide analysis. Obesity. 2017;25(3):522–6.CrossRefGoogle Scholar
  16. 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.CrossRefGoogle Scholar
  17. 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.CrossRefGoogle Scholar
  18. 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.CrossRefGoogle Scholar
  19. 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.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.MedStar Washington Hospital Center, MedStar Georgetown University HospitalWashington, DCUSA
  2. 2.Canton-Potsdam HospitalPotsdamUSA

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