A morbidly obese female with a body mass index of 50.7 kg/m2 and comorbidities of back pain and migraine headaches was taken to the operating room for a laparoscopic Roux-en-Y gastric bypass. She was incidentally found to have intestinal malrotation. The Roux-en-Y gastric bypass was completed laparoscopically, followed by laparoscopic division of Ladd's bands, and appendectomy.