[A heavily pregnant woman with acute abdominal pain]

Internal herniation is a recognised complication following Roux-en-Y gastric bypass (RYGB) and may lead to life-threatening conditions. The diagnosis of abdominal emergencies in pregnant patients who have undergone bariatric surgery is particularly challenging due to physiological and anatomical changes.

A woman in her late twenties, at 37 + 5 weeks' gestation, presented with severe acute abdominal pain. She initially underwent an uncomplicated vaginal delivery but rapidly deteriorated postpartum, developing circulatory shock. Her medical history included RYGB five years earlier and a subsequent laparoscopic procedure for mesenteric defect closure. Her abdominal pain intensified significantly postpartum and was accompanied by nausea and haematemesis. Computed tomography revealed extensive small-bowel ischaemia due to internal herniation through a mesenteric defect with associated vascular compromise. Emergency laparotomy confirmed severe bowel strangulation, requiring extensive intestinal resection and resuscitative measures.

Internal herniation after RYGB is a rare but potentially fatal complication. Pregnancy increases the risk, and delayed diagnosis and treatment may result in fatal outcomes for both the mother and the fetus. Awareness of the biomechanical changes after bariatric surgery and in pregnancy is essential for all surgeons. Prompt recognition and early surgical intervention are critical for patient survival in cases of severe internal herniation.