Question: A 64-year-old, obese women with a history of schizophrenia and multiple bariatric surgeries had been attending clinics for 4 years for assessment and adjustment of her gastric band. The patient had largely been unsuccessful in losing weight and had remained oscillating around a body mass index of 46 kg/m2. In November 2016, a computed tomography scan revealed 2 hernias, which were to be repaired after further weight loss (Figure A). Two months later, the patient presented to accident and emergency with vomiting and severe abdominal pain.