Charcoal peritonitis causing chronic pelvic pain: a unique complication following bariatric surgery

Routine pathologic examination of a specimen transformed a common diagnosis of endometriosis into a search for an unusual cause of recurrent pelvic pain. Laparoscopy was suspicious for endometriosis, but instead on microscopic examination a black pigment of unknown origin was present. In a subsequent interview with her gynecologist the 38-year-old patient divulged a previous Roux-en-Y gastric bypass (RYGBP), followed 8 weeks later by a suicide attempt by overdosing on medication, treated with charcoal gastric lavage. Her tiny gastric pouch was perforated and she developed charcoal peritonitis. If the emergency room physicians had been aware of her recent RYGBP, they may not have performed the lavage, and if the gynecologist had been aware of the history, she may not have been incorrectly diagnosed endometriosis.