HighlightsSince early postoperative nausea and vomiting are fairly common, a high index of suspicion was essential for the diagnosis.Taking into account the asymptomatic intrathoracic sleeve migration described in the literature, thoracic cuts of the CT Scan are essential in post sleeve evaluation.Sleeve gastrectomy might disrupt the lower esophageal sphincter pressure and aggravate a pre-existing asymptomatic weak sphincter.The only other 2 reported cases occurred in the setting of a hiatal hernia. In ours no hiatal defect was observed.

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Introduction Obesity and the associated metabolic syndrome are global health problems. Significant weight loss after bariatric surgery can cause a substantial difference in those comorbidities in obese patients. In this case, we described a rare complication of a patient who developed acute liver failure after an uneventful one anastomosis gastric bypass treated conservatively and revision of the one anastomosis gastric bypass to normal anatomy. Case presentation We present a 52-year-old female known to have hypothyroidism and morbid obesity with a BMI of 45. For that, she underwent uneventful one anastomosis gastric bypass. Later, she developed liver failure and hepatic encephalopathy, which was managed conservatively and revision surgery to normal anatomy. Discussion Bariatric surgery plays an integral role in treating obese patients for its associated impacts, like facilitating weight loss and related metabolic syndrome improvement. The effects of bariatric surgery on liver functioning are controversial. Some malabsorptive procedures are linked to postoperative hepatic complications. However, it is uncommon in a recent new technique in bariatric surgery. Liver transplant and revision of the bariatric surgery have been described as management. However, optimal nutrition support without a liver transplant along with revision surgery is possible in experienced hands. Conclusion Early detection of liver impairment and early intervention by a revision to normal anatomy by an experienced surgeon is considered the safest and most effective procedure for such patients. However, late detection where liver failure occurs, liver transplantation is the only effective treatment for preventing fatal outcomes.