The Los Angeles medical examiner ruled Presley died of natural causes and, in a report issued last week, linked her small bowel obstruction to bariatric surgery she had years earlier. CNN, which first obtained the autopsy, said it included the official opinion of deputy medical examiner Juan M. Carrillo, MD, who said the obstruction was caused by “adhesions (or, scar tissue) that developed after bariatric surgery years ago. This is a known long-term complication of this type of surgery.”
Surgery experts don’t dispute that a cutoff of blood supply to her small bowel, also known as the small intestine, led to her death. But they’re less certain that internal scarring from previous weight loss surgery is to blame.
Presley reported belly pain earlier that day, according to the medical examiner. It’s unclear if her pain had persisted for days or come and gone in severe bouts, which are common signs of bowel obstruction. Vomiting and abdominal distention – when air or fluid gathers in the belly and causes it to expand – are also common.
In many cases, bowel obstructions can be treated if medical care is sought early enough. “The message is obviously if you have abdominal pain, and it’s persistent abdominal pain, go see a physician,” Kurian said.
Bariatric surgery includes many different procedures, and Kurian thinks from the medical examiner’s report that Presley most likely had a single anastomosis duodenal ileostomy (SADI). This kind of procedure lowers food intake by reducing the stomach size and limiting the absorption of food by bypassing part of the small intestine.
Dr. Stacy Brethauer, bariatric surgeon, warns untreated bowel obstructions may cause blood supply cut off, as in Ms. Presley’s case.
Brethauer stated that the majority of bariatric surgeries past two decades were minimally invasive, reducing scarring compared to open surgery.
Short- and Long-Term Risks
Overall, the risks of bad outcomes after weight loss surgery are “very, very low,” Kurian said. Short-term risks include leaks, bleeding, infection, and blood clots. Long-term adverse effects can include bowel obstruction and malnutrition. The risk of malnutrition from lower absorption of nutrients can be lessened by patients taking multivitamins, for example.
For the vast majority of patients seeking bariatric surgery, the benefits far outweigh the risks, both in the short term and long term, Brethauer said. Benefits include a significant reduction in long-term deaths, cancer risk, cardiovascular disease, and diabetes.
“Physicians should counsel patients that bariatric surgery, like any surgical procedure, has some inherent risks,” he added. Mortality rates are currently less than 0.1% and major short- and long-term complication rates range from 1% to 4%.
Risks differ based on patients and bariatric procedures (sleeve gastrectomy, Roux-en-Y gastric bypass, adjustable gastric band).
Anti-Obesity Medications vs. Surgery?
Kurian expressed doubt about decreasing weight loss surgery due to the popularity of anti-obesity medications like Wegovy and Ozempic.
Kurian believes surgery offers a more durable approach to treating severe obesity.
Customize obesity treatment, meds, or surgery based on discussions between patients and doctors, considering individual needs. It also depends, in part, on how much weight a person would need to lose to be healthier, Kurian said.
“These medications are a fantastic addition to our armamentarium for the treatment of obesity,” Brethauer said. “Injectables mimic gut hormone changes post-bariatric surgeries, e.g., gastric bypass, sleeve gastrectomy, and duodenal switch.”
On the plus side, more people are talking about obesity with the popularity of Wegovy, Ozempic, and other anti-obesity medications. Kurian’s insight removes obesity stigma, highlighting that it’s beyond diet and exercise, fostering understanding and empathy.
“People gaining insight into weight struggles as they learn about physiological and hormonal factors affecting weight loss—empowering and reassuring.”