This case involves the death of a middle-aged man who had recently undergone gastric bypass surgery from an internal hernia. The man had called the office of his gastric surgeon and reported a severe constipation problem. Despite his serious complaints, he was never referred to the ER. A few days later, he presented to the ER where he was found to be tachycardic and hypotensive. A CT Scan showed bowel ischemia, and a plan was made to operate on the patient when he was stabilized. Over the next several hours the patient continued to deteriorate, and the decision was made to operate emergently, however the patient died before surgery could be performed. An autopsy reported that the cause of death was a gangrenous internal hernia.