‘Botched’ star Dr. Terry Dubrow — board certified plastic surgeon — spoke about bariatric surgery and some of the complications that can occur
Earlier this week, Lisa Marie Presley’s cause of death was revealed. The 54-year-old singer-songwriter died in January from a “sequelae of a small bowel obstruction,” which developed after she underwent bariatric surgery several years ago, according to an autopsy report obtained by PEOPLE.
As noted in the report, the obstruction was in the form of a strangulated small bowel caused by adhesions that developed after her weight-loss surgery. “This is a known long-term complication of this type of surgery,” noted Deputy Medical Examiner Dr. Juan Carrillo.
Bariatric surgery — a collective term for gastric bypass and other weight loss surgeries — involves surgically modifying the digestive system, typically the stomach and small intestine, in order to reduce the amount of food an individual can eat and absorb.
Dr. Terry Dubrow, a board-certified plastic and reconstructive surgeon and star of Botched, about the procedure and some potential complications.
“The thing about bariatric surgery is there’s a few different kinds,” he says. “They vary from completely disconnecting parts of the intestines, so you don’t absorb very much, or it involves reducing the size of the stomach, which limits the amount of food you eat.”
In order to undergo bariatric surgery, patients are required — typically by insurance companies — to have a body mass index (BMI) of greater than 40 and have an associated medical condition for which obesity is one of the major risk factors, Dubrow says, noting that he assumes Presley’s surgeon would have made sure she met those weight requirements.
As with any major procedure, bariatric surgery poses potential health risks that can lead to short-term, long-term and fatal complications.
Dubrow — who is also board certified in general surgery — said the most common complications from bariatric surgery are those called malabsorption syndromes, where the patients are not absorbing the usual amounts of vitamins that would be absorbed through a regular diet.
“You’re not absorbing enough vitamin b12 so you’re getting anemic, you’re not absorbing enough nutrients so you can get skin conditions. It’s mainly mechanical,” he adds, noting the importance of patients getting their blood levels tested before and after surgery.
Additionally, another complication of bariatric surgery is a small bowel obstruction, which is what led to Presley’s death.
“The problem is when you go inside the abdomen and you either disconnect part of the intestines to limit absorption or you operate on the stomach itself to limit the volume that you can eat, you induce scarring in and around the area of the intestines. And those are called adhesions,” he explains.
“The most common complication of that kind of surgery is when that scarring is in there, it sometimes can catch pieces of the bowel, or it can impair intestinal motility — the movement of food — and that causes what’s called a small bowel obstruction,” Dubrow continues. “That happens in about 6% of all bariatric type surgery.”
Symptoms of a small bowel obstruction start with “uncomfortable kind of bloating,” according to Dubrow. That then leads to painful nausea and vomiting. However, many people dealing with this kind of blockage don’t realize the cause because symptoms can often seem like the flu or a stomach ache.
“And this is not something that necessarily happens immediately after the surgery,” Dubrow adds. “This can happen two years, five years, 10 years later. You’re basically always at a risk for intermittent small bowel obstruction.”
Many times a small bowel obstruction can resolve on its own. However, if it continues to the point where it doesn’t allow the food to progress through the body, swelling can occur, which can cut off blood supply.
“Once the blood supply to the intestines gets cut off, that can result in small bowel necrosis, meaning your intestines die,” Dubrow says. “So you can be walking around with a tummy ache, you can have a small bowel obstruction and unbeknownst to you, inside of the abdomen, your intestines are dying. Once your intestines die enough, that is life-threatening.”
Additionally, the toxicology results in Presley’s autopsy also concluded that levels of oxycodone remained in her blood at the time of death. Months prior, she had another cosmetic surgery and was prescribed medicine for the pain.
Dubrow — who stresses that he was not Presley’s doctor — believes that the combination of bariatric surgery and pain medication could have been the “perfect storm” of predisposing factors to the small bowel obstruction.
“Oftentimes when you have plastic surgery, you often take pain pills, you take opioids. They found oxycodone in Lisa Marie, which is very common to take after plastic surgery,” he explains. “But when you take opioids, that also slows down the intestinal tract.”
“So if you have a combination of previous gastric bypass surgery with scarring and you take opioids from recent plastic surgery, that can predispose you to a small bowel obstruction,” he adds.
Dubrow urges patients who have had bariatric surgery to be more concerned with any symptoms that arise and seek medical attention.
“Don’t just assume it’s a tummy ache. Don’t just assume you have the flu. If you have nausea, vomiting, bloating, abdominal pain, be a lot more concerned that you may be developing or have developed a small bowel obstruction,” he says.
“You need to have a higher index of suspicion that this could be a problem,” Dubrow tells PEOPLE. “Don’t let it go all day, all night into the next day. You want to go to your urgent care and get a very simple x-ray of your abdomen that can instantly determine whether you have a small bowel obstruction.”
