Severe hypernatremia and rhabdomyolysis 30 days after laparoscopic sleeve gastrectomy: a case report

Rhabdomyolysis is an uncommon but potentially life-threatening complication of bariatric surgery, typically occurring in the immediate postoperative period and associated with prolonged operative time, improper positioning, or extreme obesity. We report a 16-year-old female with class III obesity who underwent uneventful laparoscopic sleeve gastrectomy and was discharged on postoperative day 1. Approximately 30 days later, she presented with progressive weakness, myalgia and severe hypernatremia, elevated creatinine and creatine phosphokinase, suggestive of rhabdomyolysis. She was managed with aggressive intravenous hydration and gradual correction of hypernatremia, with full recovery of muscle strength and renal function. This case highlights a delayed presentation of severe hypernatremia and rhabdomyolysis following laparoscopic sleeve gastrectomy in an adolescent patient. Clinicians should maintain a low threshold for checking creatine phosphokinase and electrolytes in post-bariatric patients with myalgia, weakness, or dark-colored urine, regardless of the time elapsed since surgery.