The Unexpected Evolution of an Expected Complication: Hemophagocytic Lymphohistiocytosis

Severe obesity is associated with consistent morbidity and mortality. Bariatric surgery is presently the most effective treatment for this condition, and laparoscopic Rouxen-Y gastric bypass (RYGB) is the most common surgical procedure performed. RYGB carries a mortality risk of 0.5–1.9%. One fearedearly surgical complications is postoperative leak,occurringin2.1–5.2% of patients and having a mortality rate up to 50%. Hemophagocytic lymphohistiocytosis (HLH) is a rare disease, characterized by an uncontrolled inflammatory response that leads to systemic compromise and in the end to death by multi-organ failure, bleeding, sepsis, or disseminated intravascular coagulation (DIC). We report the first case of HLH associated with complicated bariatric surgery, investigating possible reasons for this association