Emergency Imaging of the Bariatric Surgery Patient

Bariatric surgery remains the only treatment for obesity with established outcomes and durable weight loss. Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and laparoscopic adjustable gastric band (LAGB) represent the most commonly performed surgeries and constitute over 80% of the procedures currently performed. Unfortunately, complications after these surgeries are not uncommon, and many patients with surgical complications present acutely in the emergent setting. Imaging, computed tomography (CT) in particular, plays an important role in the care of the bariatric surgery patient by readily depicting postoperative complications and guiding further management. The most common complications of RYGB include gastrointestinal leak, postoperative hemorrhage, anastomotic stricture or ulceration, small bowel obstruction, hernia, and intussusception. Complications after SG include leak, hemorrhage, and gastric stricture. Finally, complications after LAGB include stomal stenosis, band slippage, band erosion, and port/tubing complications. The goal of this chapter is to review the normal postoperative appearance of these bariatric surgical procedures and discuss and illustrate the most commonly encountered surgical complications of each.