Background

Bariatric surgery among morbidly obese heart failure (HF) patients is a relatively new phenomenon. Patients with end-stage HF may be precluded from obtaining a heart transplant due to morbid obesity. Roux-en-Y gastric bypass can offer a pathway for these patients to qualify for heart transplant through surgical treatment of their obesity. Complications in this patient population can range from bleeding, internal hernias, and anastomotic leak. We present the case of a 34-year-old female with a left ventricular assist device (LVAD) who underwent a laparoscopic Roux-en-Y gastric bypass, complicated by a small bowel obstruction secondary to an intraluminal blood clot. She returned to the operating room on postoperative day two for an exploratory laparotomy, where an intraluminal blood clot was discovered at the jejunojejunostomy. This was evacuated via an enterotomy on the biliopancreatic limb. The enterotomy was closed primarily without the need for anastomotic revision. The patient recovered well and was discharged home on her oral anticoagulation. In a patient population with severe concurrent cardiac comorbidities, it is critical to maintain awareness of all potential complications when undergoing bariatric surgery. This can help clinicians take prompt action and avoid significant morbidity and potentially mortality.