Background

This case report highlights a safe minimally invasive approach in a patient with a complex medical history and a bariatric emergency. The patient had a history of previous gastric bypass, metastatic renal cell carcinoma, and NASH cirrhosis. He presented with abdominal pain and PO intolerance and was found to have an incarcerated internal hernia causing an obstruction and a perforation at the jejunojejunostomy. In the operating room we were able to utilize a laparoscopic approach to reduce the internal hernia and close the perforation and hernia defect. A formal revision of the anastomosis was deferred given his risk of complications from bleeding or poor anastomotic healing in the setting of cirrhosis and hypoalbuminemia.