According to a letter published in the Aug. 12 issue of the New England Journal of Medicine, the AP/Detroit News reports (Johnson, AP/Detroit News, 8/12).

The 41-year-old woman went to her local hospital at 31 weeks gestation with sudden stomach pain, nausea and vomiting, according to a letter written by doctors at Brigham and Women's Hospital in Boston. After 48 hours, the patient was transferred to Brigham and Women's obstetrical department with a presumed diagnosis of pancreatitis.

At that time, doctors discovered that the fetus was no longer viable. The woman then underwent emergency surgery, during which doctors discovered that most of the woman's small intestine had herniated through a tear in an adjacent membrane, a defect that sometimes results when the intestines are rearranged during gastric bypass surgery.

The hole had cut off the blood supply to the woman's intestines and had caused them to become gangrenous. Surgeons removed 61 cm of her small intestine and the nonviable fetus, but the woman died three hours after the procedure (Moore et al., NEJM, 8/12). The woman's death is believed to be the first fatality of a pregnant woman as a result of gastric bypass, according to the AP/News.

Ramifications

Doctors at Brigham and Women's Hospital who treated the woman said that her death raises concerns because the majority of the 110,000 people who undergo gastric bypass surgery each year in the United States are women of childbearing age, the AP/News reports (Johnson, AP/Detroit News, 8/12).

In addition, weight loss among morbidly obese women often results in increased sexual activity and improved fertility. As a result, doctors expect the number of women who undergo gastric bypass and become pregnant to increase (NEJM, 8/12).

Dr. Harvey Sugerman, president of the American Society for Bariatric Surgery, said that the woman's death "is a tragic case, but you need to look at the overall risk-benefit of the surgery," according to the AP/News.

Sugerman said that three studies have shown that extremely obese people who have bariatric surgery have death rates four to five times lower than obese individuals who do not have the surgery. According to the AP/News, about 20% of all patients who undergo gastric bypass will experience complications and 0.5% to 2% will die. Dr. Sattar Hadi, who runs a high-risk obesity clinic at Vanderbilt University's Center for Human Nutrition, said that most physicians recommend that women who undergo the surgery use contraceptives to avoid pregnancy for two years after the operation, according to the AP/News. Dr. Mark Tucker, director of bariatric surgery at the University of Medicine and Dentistry of New Jersey, said that hernias similar to the one experienced by the woman who died are common up to five years following gastric bypass (AP/Detroit News, 8/12).