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VOLUME 14 , ISSUE 2 ( May-August, 2021 ) > List of Articles

CASE REPORT

Gastric Remnant Perforation after Roux-en-Y Gastric Bypass: A Case Report and Literature Review

Carlota Tuero, Gorka Docio, Victor Valenti, Alicia Artajona, Soledad Monton

Keywords : Bariatric surgery complications, Emergency surgery, Gastric bypass, Gastric remnant perforation, Pyloric perforation

Citation Information : Tuero C, Docio G, Valenti V, Artajona A, Monton S. Gastric Remnant Perforation after Roux-en-Y Gastric Bypass: A Case Report and Literature Review. World J Lap Surg 2021; 14 (2):141-143.

DOI: 10.5005/jp-journals-10033-1458

License: CC BY-NC 4.0

Published Online: 19-08-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aim and objective: The aim and objective of this article was to focus on long-term complications after bariatric surgery, which are usually managed by general surgeons in the emergency department. Background: Roux-en-Y gastric bypass (RYGBP) is one of the most commonly performed bariatric techniques in the world. Gastric remnant complications after this procedure are infrequent and poorly known. Furthermore, the diagnosis of this pathology may be challenging. Case description: We present the case of a 54-year-old woman with intense epigastric pain and history of uncomplicated laparoscopic RYGBP 18 years ago. After clinical, laboratory, and radiological examinations, the patient was diagnosed with a gastric remnant perforation. Laparoscopic surgery was performed, and the perforation was successfully repaired with primary suture and omental patch. Conclusion: Gastric remnant perforation after bariatric surgery is not frequent and usually appears several years after the procedure. This type of pathology is presented without specific clinical manifestations and with few analytical alterations. Complementary radiological studies, such as computed tomography (CT) scan, should be performed. However, pneumoperitoneum and extravasation of oral contrast are usually absent. Depending on the size of the defect, primary suture or gastric remnant resection may be performed. Nevertheless, surgical treatment should not be delayed. Clinical significance: Long-term complications after bariatric surgery are in many circumstances managed by general practitioner surgeons. The low incidence and scarce manifestations make the diagnosis of this pathology challenging. Furthermore, bariatric surgery is progressively increasing its presence all over the world. Complications after this procedure must be known and kept in mind because an early diagnosis is crucial to give a proper treatment and reduce morbidity and mortality.


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  1. Plitzko G, Schmutz G, Kröll D, et al. Ulcer disease in the excluded segments after Roux-en-Y gastric bypass: a current review of the literature. Obes Surg 2020;31(3):1280–1289. DOI: 10.1007/s11695-020-05123-w.
  2. Iranmanesh P, Manisundaran NV, Bajwa KS, et al. Management of acute gastric remnant complications after Roux-en-Y gastric bypass: a single-center case series. Obes Surg 2020;30(7):2637–2641. DOI: 10.1007/s11695-020-04537-w. Available from: https://pubmed.ncbi.nlm.nih.gov/32162207/.
  3. Iskandar ME, Chory FM, Goodman ER, et al. Diagnosis and management of perforated duodenal ulcers following Roux-En-Y gastric bypass: a report of two cases and a review of the literature. Case Rep Surg 2015;2015:1–4. DOI: 10.1155/2015/353468. Available from: https://pubmed.ncbi.nlm.nih.gov/pmc/articles/PMC4408622/?report=abstract.
  4. Ovaere S, Tse WHW, Schipper EE, et al. Perforation of the gastric remnant in a patient post-Roux-en-Y gastric bypass. BMJ Case Rep [Internet]. 2016;2016. DOI: 10.1136/bcr-2015-213862. Available from: https://pubmed.ncbi.nlm.nih.gov/pmc/articles/PMC4785498/?report=abstract.
  5. Dai L, Shah MM, Rosenblatt S. Perforated gastric remnant ulcer after laparoscopic gastric bypass. BMJ Case Rep 2018;2018. DOI: 10.1136/bcr-2017-222190. Available from: https://pubmed.ncbi.nlm.nih.gov/29622702/.
  6. Bjorkman DJ, Alexander JR, Simons MA. Perforated duodenal ulcer after gastric bypass surgery. Am J Gastroenterol 1989;84(2):170–172.
  7. Tornese S, Aiolfi A, Bonitta G, et al. Remnant gastric cancer after Roux-en-Y gastric bypass: narrative review of the literature. Obes Surg 2019;29(8):2609–2613. DOI: 10.1007/s11695-019-03892-7. Available from: https://pubmed.ncbi.nlm.nih.gov/31001760/.
  8. Cleator LGM, Rae A, Birmingham CL, et al. Ulcerogenesis following gastric procedures for obesity Obes Surg 1996;6(3):260–261. DOI: 10.1381/096089296765556881. Available from: https://pubmed.ncbi.nlm.nih.gov/10729870/.
  9. Csendes A, Burgos AM, Smok G, et al. Endoscopic and histologic findings of the foregut in 426 patients with morbid obesity. Obes Surg 2007;17(1):28–34. DOI: 10.1007/s11695-007-9002-9. Available from: https://pubmed.ncbi.nlm.nih.gov/17355765/.
  10. Gypen BJ, Hubens GJA, Hartman V, et al. Perforated duodenal ulcer after laparoscopic gastric bypass. Obes Surg 2008;18(12):1644–1646. DOI: 10.1007/s11695-008-9530-y. Available from: https://pubmed.ncbi.nlm.nih.gov/18443886/.
  11. Pohl D, Schmutz G, Plitzko G, et al. Perforated duodenal ulcers after Roux-Y Gastric Bypass. Am J Emerg Med 2018;36(8):1525.e1–1525.e3. DOI: 10.1016/j.ajem.2018.04.057. Available from: https://pubmed.ncbi.nlm.nih.gov/29716802/.
  12. Satoh K, Yoshino J, Akamatsu T, et al. Evidence-based clinical practice guidelines for peptic ulcer disease. J Gastroenterol 2016;51(3):177–194. DOI: 10.1007/s00535-016-1166-4. Available from: https://pubmed.ncbi.nlm.nih.gov/26879862/.
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