Unrecognized pregnancy prior to bariatric surgery: case report and review of implications

Abstract

SummaryA substantial proportion of patients undergoing bariatric surgery are female and of reproductive age. Guidelines suggest that pregnancy should be avoided for 12–18 months following bariatric surgery, and that women be appropriately counselled regarding contraception. We present a case in which a patient underwent a Roux‐en Y gastric bypass while unknowingly in the early stages of pregnancy. After a six‐week period liquid meal replacement for perioperative weight loss, a laparoscopic Roux‐en Y gastric bypass, and a short course of oral antibiotics for a post‐operative wound infection, the patient developed epigastric pain, odynophagia, oesophageal dysphagia, bloating and nausea with oral intake. Only after an abdominal X‐ray, two upper endoscopies and an upper gastrointestinal series was an intrauterine pregnancy seen incidentally on abdominal ultrasound. Ultimately, the patient underwent elective termination of her pregnancy. Patients who are, or are planning to soon become, pregnant should not undergo bariatric surgery. All female patients of reproductive age should be counselled on the importance of effective birth control prior to planning bariatric surgery. Beta‐human chorionic gonadotropin testing should be routinely considered before embarking on meal replacement or surgery.