Managing bariatric patients in a children’s hospital: radiologic considerations and limitations Thomas H. Inge a,b, * , Lane F. Donnelly a,c , Mark Vierra d , Aliza P. Cohen b , Stephen R. Daniels a , Victor F. Garcia a,c a Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229-3039, USA b Department of Pediatric Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229-3039, USA c Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229-3039, USA d Private Surgical Practice, Community Hospital of Monterey Peninsula, Monterey, CA 39340, USA Abstract As the increasing prevalence of pediatric obesity and its associated risks gain national attention, adolescent bariatric surgery is gradually gaining acceptance as a viable weight loss tool for some severely obese adolescents. Obese patients often exceed the capacity limits of most radiological devices used for imaging. Because the radiological evaluation often plays a crucial role in the management of these patients, it is important for pediatric surgeons and radiologists to be aware of the special challenges and alternative algorithms for radiological evaluation. This review outlines and illustrates these considerations and limitations. Herein the authors discuss these topics within the context of characteristic bariatric patient profiles and the Roux-en-Y gastric bypass procedure, currently the authors’ standard operative approach. D 2005 Elsevier Inc. All rights reserved. As with adult obesity, pediatric obesity in the United States has reached epidemic proportions. Its prevalence has tripled over the last 3 decades and is currently estimated to be between 15.5% and 37% [1-3]. The health consequences of this condition are often severe, encompassing serious psychosocial problems and a wide spectrum of serious comorbid medical conditions that can manifest during childhood or in adulthood. Medical comorbidities include hyperlipidemia, glucose intolerance, diabetes mellitus type 2, nonalcoholic steatohepatitis, obstructive sleep apnea, hy- pertension, deep vein thrombosis, and pulmonary embo- lism [4,5]. In light of these risks, bariatric surgery in adolescents is gradually gaining acceptance as a viable weight loss tool in a select group of severely obese adoles- cents [6,7], and pediatric centers are increasingly establish- ing multidisciplinary teams to assess potential surgical candidates [8,9]. Unlike the adult bariatric surgical experience, more than half of our adolescent bariatric surgical patients exceed 350 lb at presentation. The risk of complications is highest during the first 3 months after gastric bypass surgery. Although they generally lose 50 to 75 lb over that time interval, be- cause of their excess weight and size, they present a number of special radiological challenges to the pediatric sur- geons and radiologists. This review discusses these chal- 0022-3468/05/4004-0001$30.00/0 D 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.jpedsurg.2005.01.005 T Corresponding author. Division of Pediatric Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229-3039, USA. Tel.: +1 513 636 8714; fax: +1 513 636 7657. E-mail address: thomas.inge@cchmc.org (T.H. Inge). Index words: Roux-en-Y; Pediatric obesity; Bariatric surgery Journal of Pediatric Surgery (2005) 40, 609–617 www.elsevier.com/locate/jpedsurg