29 year-old male one day post gastric bypass with abdominal pain.
Findings: Massive distention of the native stomach with blood and active bleeding. Normal gastric pouch
Teaching point: In a gastric bypass pt, distention of the native stomach is abnormal and this degrees of native stomach is a surgical/IR emergency for immediate decompression. Most cases are caused by bad ileus of stricture and the distal anastamosis. This is the first case I have seen with the cause being acute GI bleed probably from staple injury. Pt went to surgery within one hour of the scan and had lot of blood removed from the stomach. There was no active bleeding during the surgery and pt is doing well. If you see a case like this make note of the degrees of native stomach distention and alert the surgeon.