This case report describes a procedure-related mortality due to abdominal compartment syndrome following endoscopic stomal reduction as a revisional procedure for Roux-en-Y gastric bypass. This procedure is increasing in popularity due in part to the well-documented safety profile. Case Description: The patient presented recurrent morbid obesity and GERD 11 years following Roux-en-Y gastric bypass and underwent a laparoscopic hiatal hernia repair and transoral outlet reduction. Severe

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... developed following this 45-minute endoscopic procedure leading to ischemia of the bilateral lower extremities. Urgent laparotomy was performed to relieve the compartment syndrome but the patient developed refractory disseminated intravascular coagulation (DIC), cardiogenic shock, and succombed. Discussion: Although a rare event, patients undergoing prolonged endoscopic procedure using air insufflation under general anesthesia may be at risk.