This patient is a 61 year old morbidly obese male an actual body weight of 448 pounds, ideal body weight of 157 pounds, and a BMI of 65. The patient underwent a laparoscopic retrocolic antegastric roux-en-y gastric bypass 10 months prior to this admission. During this time he lost approximately 130 lbs and a BMI of 45. He presented to the hospital with 5 hour history of nausea, light brown emesis, and crampy abdominal pain. An upright abdominal x-ray showed dilated loops of small bowel in the left upper quadrant consistent with a small bowel obstruction. The patient was taken to the operating room for laparoscopic exploration. The patient was found to have an internal hernia of the retrocolic roux limb through both the transverse mesocolon as well as the gastrocolic omentum. The point of obstruction was the defect in the gastrocolic omentum where the roux limb was incarcerated. The hernia was reduced and the defect in the transverse mesocolon was closed. The patient was discharged from the hospital on postoperative day 4 after return of bowel function and is currently doing well one month after discharge.