A 16 year old female with severe obesity underwent 6 months of multidisciplinary evaluation, after which she was offered laparoscopic sleeve gastrectomy. At surgery, peritoneal access was obtained using a 5mm non-cutting optical port. Sleeve gastrectomy was performed using a 40Fr bougie and multiple staple firings with bioabsorbable staple line reinforcement.
On the second post-operative day she was noted to have a low grade fever and low urine output. Her physical exam was otherwise unremarkable and her wbc = 12,900. That evening a computed tomograph of the abdomen with oral contrast showed pneumoperitoneum, no extravisation of contrast from the gastric sleeve, and thickened bowel loops in the left upper abdomen. The following morning she complained of mild diffuse abdominal pain and return to the operating was carried out. At repeat laparoscopy she was found to have a through-and-through injury to the proximal small intestine. The bowel was repaired primarily
