Bariatric surgery is increasingly becoming an option for the treatment of morbid obesity. Patients who have undergone gastric bypass surgery have varied post-surgical complications which present acutely in the emergency medical setting, particularly internal hernias. It may be difficult to identify an internal hernia in the absence of intestinal obstruction. This article will review the various types of imaging presentations to highlight the complexity of making a radiographic diagnosis. Recognition of internal hernia as the cause of intermittent or acute abdominal pain symptoms in these patients in the emergency setting can prompt immediate surgical intervention, thus avoiding life-threatening outcomes.