Postmortem evaluation of deaths in individuals with a history of bariatric surgery: Autopsy and histopathological findings

Abstract

Background: Bariatric surgery effectively treats morbid obesity, but postoperative deaths may present diagnostic and medicolegal challenges. Determining whether death is related to surgery often requires combined interpretation of autopsy and histopathological findings. Aim: This study aimed to evaluate autopsy and histopathological findings in deaths occurring in individuals with a history of bariatric surgery and to assess their contribution to determining the cause of death and its relationship to bariatric surgery. Methods: This retrospective autopsy-based case series included medicolegal autopsies with a history of bariatric surgery examined at the Council of Forensic Medicine between 1 January 2019 and 31 December 2025. Demographics, procedure type, surgery-to-death interval, autopsy findings, histopathology, and cause of death were recorded. Deaths were classified as surgery-related or unrelated based on combined forensic, pathological, and clinical evaluation. Results: A total of 51 cases were included. Mean age at surgery was 36.1±10.7 years; 58.8% were female. Sleeve gastrectomy was the predominant procedure (50/51, 98%). Death was considered surgery-related in 24 cases (47.1%) and unrelated in 27 (52.9%). In surgery-related deaths, the median interval was 10 days and 75% occurred within 30 days. Common autopsy findings were perforation, anastomotic leakage, intra-abdominal hemorrhage, and findings consistent with peritonitis or sepsis. Histopathology most frequently showed acute peritonitis, acute inflammation, gastrointestinal wall necrosis, and microthrombi. Infectious and septic complications predominated. Conclusions: Deaths in individuals with a history of bariatric surgery represent a pathologically and forensically heterogeneous group. Autopsy and histopathological examination are essential for determining the cause of death and its relationship to bariatric surgery.