Management of a perforated gastric bypass after motor vehicle collision with complex revisional reconstruction: A case report

Altered anatomy secondary to bariatric surgery is an increasingly common challenge for operative planning in patients needing emergency surgical interventions. Bariatric surgical patients in general, and especially patients with prior Roux-en-Y gastric bypass (RYGB), present unique challenges in the emergency setting, where altered anatomy and difficulty obtaining prior operative information urgently may obscure diagnosis and complicate surgical management. Traumatic injuries to RYGB anatomy are rare but can result in devastating ischemic or perforating injuries requiring complex reconstruction. We report a case of a patient found to have RYGB anatomy following severe blunt trauma leading to hollow viscus perforation and peritonitis. The patient was found to have a destructive injury to their RYGB requiring complex reconstruction of a new RYGB configuration with appropriate limb lengths. The case highlights the importance of familiarity of anatomy associated with weight loss procedures and need for thoughtful, multidisciplinary approach to reconstruction to optimize both short and long-term patient outcomes.