Background

The teaching points for this presentation will be based on the case of a 72-year-old male with a distant history of laparoscopic Roux-en--Y gastric bypass who presented with necrotic bowel through an internal hernia, which was resected by the acute care surgery service. With the patient in discontinuity, the bariatric surgery service was consulted for damage control assessment and management of his complormised remaining small intestine, and resultant short bowel syndrome. We will discuss damage control strategies for drainage of the limbs of his prior gastric bypass, highlight techniques for perfusion assessment of the remaining bowel prior to definitive abdominal closure, and review the nutritional as well as medication management of his unusual remaining anatomy as a bridge to reestablishing intestinal continuity.