Solution: Gastric bypass is becoming an increasingly common surgery and is being performed in increasingly younger patients. As this has happened, it has become clear that there are many potential complications associated with this procedure. This case shows one of the more common delayed complications, namely an internal hernia through the mesentery (note the small bowel wrapping around the SMA and SMV centrally with clustered dilated small bowel in the anterior abdomen) that in this case is associated with volvulus of the small bowel. Fortunately, this patient was taken to the OR in time to reduce the hernia and save the small bowel, but particularly with laparoscopic techniques, there is often a defect in the mesentery after this surgery that leaves the patient susceptible to this complication. If you see a high-grade obstruction in these patients, you should consider this diagnosis.