Early Presentation of Internal Hernia After Laparoscopic Roux-en-Y Gastric Bypass

Internal hernia is a potentially serious complication of laparoscopic Roux-en-Y gastric bypass (LRYGB), usually presenting months to years after surgery. Early postoperative internal hernia that occurs within the first week is exceptionally rare and may be difficult to diagnose due to nonspecific symptoms and misleading initial imaging. We report a case of a 58-year-old female who developed acute epigastric pain and vomiting on the sixth postoperative day following revisional LRYGB with hiatal hernia repair. The initial upper gastrointestinal contrast study showed normal contrast passage. As the symptoms persisted, a CT was done, which demonstrated a markedly dilated biliopancreatic limb with mesenteric swirling, consistent with an internal hernia causing afferent loop obstruction. Emergency exploration revealed herniation of the biliopancreatic limb through a supracolic defect. Reduction and closure resulted in full recovery. This case highlights the importance of maintaining a high index of suspicion for internal hernia even in the early postoperative period despite appropriate closure of all mesenteric defects.