Diagnostic difficulty of pulmonary embolus in a bariatric patient and complication of therapeutic dose low-molecular weight heparin to the surgical anastomosis

Bariatric surgery is a rapidly expanding surgical speciality. A patient developed new onset shortness of breath and pleuritic chest pain post-laparoscopic gastric bypass surgery. Investigations were consistent with type 1 respiratory failure. Such patients are at high risk of venous thromboembolism. A clinical diagnosis of a pulmonary embolus was made. Treatment was initiated with therapeutic dose low-molecular weight heparin (LMWH)-enoxaparin. Subsequently she developed bleeding from the anastomotic sites. Subsequent investigations, including a CT pulmonary angiogram, diagnosed hospital-acquired pneumonia to which she has responded to antibiotic treatment. There is little in the published literature as to the successful treatment of pulmonary embolus in bariatric patients, and little about the potentially devastating bleeding from the anastomotic sites by treatment with LMWH.