Small bowel obstruction after RYGB should be treated as an urgent surgical emergency because:A) It is frequently due to an incarcerated internal hernia which can progress to bowel necrosis and perforation
Small bowel obstruction after RYGB is frequently due to an incarcerated internal hernia at the location of the closure, or lack thereof, of the mesenteric defect. This can progress rapidly to strangulation and necrosis of the bowel with subsequent perforation. Adverse outcomes with this complication have resulted in the uniform recommendation that small bowel obstruction in this setting should be regarded as a surgical emergency. Abdominal distention and difficulties with nasogastric intubation are not relevant concerns.