What is a small bowel obstruction? Lisa Marie Presley's cause of death explained

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Lisa Marie Presley's cause of death was the result of a surgery that she had undergone years before, an autopsy report confirmed. The only child of Elvis Presley, she experienced what's known as a small bowel obstruction, which sometimes occurs in people who've had bariatric surgery.

Bariatric surgery is a type of weight loss surgery, usually reserved for people who are unable to lose weight by making changes to their diet and exercise routine.

The autopsy report was made public six months after Lisa Marie Presley died at the age of 54 on Jan. 12, 2023. At the time, authorities confirmed she suffered cardiac arrest before her sudden death. She was found not breathing in her home in Calabasas, California, and was taken to the hospital, where she was later declared dead.

What did Lisa Marie Presley die from?

Lisa Marie Presley died from the after-effects, or "sequelae," of a small bowel obstruction, when part of the small intestine is blocked, according to a July 13 autopsy report by the Los Angeles Medical Examiner reviewed by TODAY.com.

The report stated her obstruction was “caused by adhesions (bands of scar tissue) that developed after bariatric surgery years ago." It went on to note that "the issue is a known long-term complication of" bariatric surgery.

Common complications that result from untreated small bowel obstruction include dead tissue — because the blockage can cut off blood flow to part of the intestine, which can result in a tear or an infection — or an infection in the abdominal cavity called peritonitis, according to the Mayo Clinic

Presley had oxycodone and other medications in her blood, but these were only at "therapeutic" levels, meaning she wasn't taking enough of these drugs for them to have contributed to her death, the report stated.

The coroner wrote in the report that, the morning of the day that Presley died, she had been experiencing pain in her abdomen. She'd complained of this symptom for months prior to her death, the coroner noted, along with feeling feverish, nausea and vomiting.

The autopsy report also revealed that while she was in the hospital, Presley's care team noticed her abdomen was extremely distended, or swollen outward, according to the Cleveland Clinic. She was also diagnosed with severe metabolic acidosis, a condition when too many acids build up in your bodily fluids, per Cleveland Clinic. This usually happens because your body is producing too much acid or the kidneys aren't removing enough acid from your blood.

Symptoms of small bowel obstruction

A small bowel obstruction is a partial or complete blockage of the small intestine, the longest section of the gastrointestinal tract, which breaks down food and absorbs nutrients before passing waste into the large intestine, according to the Cleveland Clinic.

Symptoms of small bowel obstruction include:

  • Abdominal pain

  • Cramping

  • Nausea

  • Bloating

  • Dehydration

  • Fever

  • Lack of appetite

  • Severe constipation

  • Abdominal distension

The severity and progression of symptoms depends on the type and degree of the blockage, Dr. Ali Aminian, director of the Bariatric & Metabolic Institute at the Cleveland Clinic, tells TODAY.com.

Whereas a complete blockage may cause severe pain or enlargement that progress quickly over the course of a few hours, says Aminian, a partial blockage can cause very gradual symptoms that take days or even a week to progress, he explains.

A diagnosis of small bowel obstruction is usually confirmed with an abdominal X-ray, Aminian notes.

Small bowel obstruction causes

Small bowel obstructions can be caused by a number of conditions, including:

  • Hernias

  • Tumors

  • Inflammatory bowel disorders

  • Adhesions, or bands of scar tissue from surgery

An earlier abdominal surgery is the leading risk factor for small bowel obstruction in the United States, per the Cleveland Clinic.

Any type of abdominal surgery can cause scar tissue formation, including an appendectomy, hysterectomy, bowel resection, colon resection and bariatric surgery, Aminian says.

"The scar tissues are like bands that may cause a kink or twist in the small intestines and cause the blockage," says Aminian.

If left untreated, the blockages can cause complications including a perforation, or hole, in the bowel, says Aminian. "The other complication is, because of the kink or twist, the blood supply to that section of the bowel can be compromised, and the patient may develop a dead bowel, which can be life-threatening," he explains.

In Presley's case, she had multiple adhesions in her small intestine, according to the report, and 915 centimeters of ischemic small bowel. This occurs when the arteries supplying blood to the small intestine are narrowed or blocked, which can reduce blood flow to the area, per the Mayo Clinic.

Treatment for small bowel obstruction may include placing a tube which goes from the nose to the stomach to help decompress the bowel, says Aminian, or surgery to treat the cause of the blockage or remove the diseased segment of the bowel.

"As with any severe medical problems, if left untreated these complications can lead to cardiac arrest, which is the terminal point for anyone who dies," says Aminian.

Did Lisa Marie Presley have bariatric surgery?

Presley had bariatric surgery years before she died, the autopsy report stated. It was not indicated in the report which specific procedure Presley underwent or when.

Bariatric surgery refers to a number of operations that change the digestive system to help patients lose weight. The two most common surgeries, which account for 95% of bariatric procedures in the U.S., are the gastric bypass and gastric sleeve surgery, says Aminian.

As with any surgical procedure, bariatric surgery comes with benefits and risks, Aminian says. Short-term risks associated with the surgery include excess bleeding, complications of anesthesia, infections, blood clots, he explains.

The long-term risks of bariatric surgery include bowel obstructions, hernias, gallstones, ulcers, malnutrition and, rarely, death, according to the Mayo Clinic. A small bowel obstruction caused by scar tissue from an abdominal surgery can develop weeks to years after a person is healed.

"The risk of having complication after bariatric surgery is about 3% for all complications ... and the benefits outweigh the risks," says Aminian.

Bariatric surgery is typically performed in order to reduce risk of weight-related health problems, such as heart disease, stroke, high blood pressure, liver disease, sleep apnea and Type 2 diabetes. Usually, patients who undergo these surgeries have tried to lose weight by improving their diet and exercising more, but it was unsuccessful, per the Mayo Clinic.

For people who do get bariatric surgery, lifestyle changes are necessary after recovering from the procedure in order to lose weight. For example, the American Society for Metabolic and Bariatric Surgery recommends prioritizing hydration, protein intake, regular exercise, and limiting consumption of alcohol and foods with lots of sugar and starch.

Presley has made headlines over the years due to speculation about her weight. In 2008, she sued British paper the Daily Mail for libel due to an article that speculated about the reasons for her gaining weight. At the time, she was pregnant, and she later gave birth to twins. Presley also spoke to People in 2014 about her efforts to lose weight, explaining that she'd been "eating clean" and walking 30 minutes every other day and lifting weights.

She shared that she decided to assess her health a few years prior, given that her father died at age 42.

"Knowing my family history — my father’s side is totally not healthy and they have shorter life spans, while my mom’s side is super fit with long life spans — I didn’t know where I would land. So I said, ‘OK. I’m going to play it safe and try to be as healthy as I can be,’” she told People at the time.

This article was originally published on TODAY.com