106 Acute Pancreatitis Following Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S): A Rare Postoperative Complication in a Bariatric Patient — A Case Report

Abstract Background Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) is an emerging bariatric procedure that combines sleeve gastrectomy with a loop duodeno-ileal bypass, offering both restrictive and malabsorptive effects. While it gains traction internationally, it remains infrequently performed, accounting for less than 5% of Bariatric procedures. This case describes the first SADI-S performed at our centre. While gastrointestinal and nutritional complications are recognised, acute pancreatitis in the early postoperative period is exceptionally rare, with only isolated cases reported in the literature. Case Presentation A comorbid 39-year-old woman with a preoperative BMI of >80 kg/m² underwent laparoscopic sleeve gastrectomy (LSG) in 2022. Following weight stabilisation, she proceeded to elective laparoscopic SADI-S with a BMI of 63 kg/m². On postoperative day eight, she developed acute epigastric pain, nausea and vomiting. Laboratory analysis revealed a serum lipase of 2,800 IU/L, and CT imaging demonstrated interstitial oedematous pancreatitis (Balthazar grade B) without gallstones or evidence of obstruction. An oesophagogastroduodenoscopy (OGD) was performed, revealing no stricture or ulceration at the duodeno-ileal anastomosis. The patient was managed conservatively with bowel rest, intravenous fluids, and analgesia, and made a full recovery. Discussion We present a rare case of acute pancreatitis following SADI-S. Transient anastomotic oedema or altered duodenal flow may have contributed to functional pancreatic outflow obstruction. As the use of SADI-S increases globally, recognising such atypical complications is important. Conclusions Acute pancreatitis should be considered in the differential diagnosis of early postoperative pain following SADI-S. Early endoscopic and radiological evaluation can aid diagnosis and guide conservative management.