Work-Up of Abdominal Pain in the Bariatric Patient

Bariatric patients with abdominal pain generally require prompt evaluation. Work-up varies by procedure type, as certain complications are more common with stapled procedures, others with anastomotic procedures, and others related to hardware. Band patients should have their bands deflated prior to work-up, and upper gastrointestinal (UGI) swallow study is the test of choice when available. Computed tomography (CT) scan with oral contrast is the most common modality for evaluation of other post-bariatric surgery abdominal pain, but the addition of intravenous contrast is sometimes helpful. Exploration is indicated for suspected bowel obstruction, perforated ulcer, leaks in potentially unstable patients, or for symptomatic gastric prolapse in band patients, even if CT is not available. Work-up of bariatric patients in the later setting may require ultrasound, nuclear scans, CT, stool or laboratory evaluation, upper or lower endoscopy, or contrast studies.