Vertical banded gastroplasty is a gastric restrictive operation which has been performed with very satisfactory results in our department. We present a 46 year-old male with BMI 48, who experienced rhabdomyolsis after a VBG operation, complicated by perforation of an upper pouch ulcer and subsequent gastric fistula. Cardiac and renal failure occurred, necessitating intensive therapy with catecholamines, diuretics and hemodialysis. The patient underwent multiple operations, drainage of a retroperitoneal abscess, suture of a perforated ulcer, and gastric decompression by a gastrostomy. Prolonged treatment including TPN, drainage, broad spectrum antibiotics, skin and would protection and jejunostomy feeding, were necessary to obtain an eventual successful outcome. This case demonstrates that unexpected surgical complications may occur in morbidly obese patients and how difficult and long the management of these may be. Rhabdomyolsis is a potentially life-threatening complication of bariatric surgery, and careful postoperative observation of the patient is mandatory.