Abdominal apoplexy: a rare complication following Roux-en-Y gastric bypass

Abstract

Abdominal apoplexy, defined as spontaneous intra-abdominal haemorrhage, is an uncommon complication in patients with a history of bariatric surgery. This report highlights the diagnostic challenges and management approach of this rare entity. We describe the clinical presentation, diagnostic investigations and management approach for a patient who developed abdominal apoplexy five years following Roux-en-Y gastric bypass. A 48-years-old female presented with acute-onset severe abdominal pain. Her medical history included Roux-en-Y gastric bypass, laparoscopic appendectomy and hysterectomy. Examination revealed diffuse tenderness, predominantly in the upper quadrants. Laboratory results demonstrated anaemia. Imaging studies (Ultrasound and CT) revealed extensive intraperitoneal haemorrhage with no identifiable source. Diagnostic laparoscopy confirmed haemoperitoneum without active arterial bleeding, consistent with abdominal apoplexy. Surgeons and emergency clinicians should maintain a high suspicion of abdominal apoplexy in post-bariatric surgery patients presenting with unexplained acute abdominal pain. Early diagnostic laparoscopy is crucial for diagnosis and management.